Provider Demographics
NPI:1083600456
Name:BENNETT, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6330 LBJ FWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6431
Mailing Address - Country:US
Mailing Address - Phone:972-386-7979
Mailing Address - Fax:972-494-3062
Practice Address - Street 1:6330 LBJ FWY
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6431
Practice Address - Country:US
Practice Address - Phone:972-386-7979
Practice Address - Fax:972-494-3062
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF64332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155235801Medicaid
TX155235801Medicaid
TX00H29WMedicare PIN