Individual
CHARLES E. BENNEYWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 PARK ST, BOWLING GREEN, KY 42101-1760
(270) 745-1626
(270) 842-8722
Mailing address
1606 RIDGESIDE AVE, BOWLING GREEN, KY 42104-9577
(270) 796-5179
(270) 622-2209
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
26384
KY
207R00000X
Internal Medicine Physician
26384
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64263841
—
KY
Enumeration date
02/14/2006
Last updated
07/29/2021
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