Organization
BRENT BENNETT MD PA
Active
Organization
BRENT BENNETT MD PA
Active
Other names
Brent Bennett MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT L. BENNETT M.D. (OWNER/PRESIDENT)
(512) 263-7133
Entity
Organization
Contact information
Practice address
2300 LOHMANS SPUR, #106, LAKEWAY, TX 78734-6206
(512) 263-7133
(512) 263-0451
Mailing address
2300 LOHMANS SPUR, #106, LAKEWAY, TX 78734-6206
(512) 263-7133
(512) 263-0451
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G3150
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049KZ
BCBS OF TEXAS GROUP #
TX
05
—
167436801
—
TX
01
—
DN3479
RAILROAD MEDICARE GROUP #
TX
Enumeration date
03/10/2006
Last updated
04/08/2014
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