Provider Demographics
NPI:1043353220
Name:IRA BENNETT DPM PA
Entity Type:Organization
Organization Name:IRA BENNETT DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-848-3433
Mailing Address - Street 1:1810 WELLNESS LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5357
Mailing Address - Country:US
Mailing Address - Phone:727-848-3433
Mailing Address - Fax:727-376-4141
Practice Address - Street 1:1810 WELLNESS LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5357
Practice Address - Country:US
Practice Address - Phone:727-848-3433
Practice Address - Fax:727-376-4141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55396Medicare UPIN
FL0143680001Medicare NSC