Individual
GREGORY L BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 N 8TH ST, SPRINGFIELD, IL 62701-1041
(217) 545-4238
(217) 545-2303
Mailing address
PO BOX 19658, SPRINGFIELD, IL 62794-9658
(217) 545-4238
(217) 545-2303
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036-088610
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-088610
—
IL
Enumeration date
11/22/2005
Last updated
01/20/2011
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