Individual
BRENT L. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
05
—
128045506
—
TX
01
—
8K9640
BCBS OF TEXAS INDIVIDUAL #
TX
01
—
P00123870
RAILROAD MEDICARE INDIVIDUAL #
TX
Enumeration date
03/14/2006
Last updated
10/03/2008
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