Provider Demographics
NPI:1093994824
Name:BENNETT, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N BECKLEY AVE
Mailing Address - Street 2:102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1271
Mailing Address - Country:US
Mailing Address - Phone:214-942-9333
Mailing Address - Fax:214-942-7556
Practice Address - Street 1:1330 N BECKLEY AVE
Practice Address - Street 2:102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1271
Practice Address - Country:US
Practice Address - Phone:214-942-9333
Practice Address - Fax:214-942-7556
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC6861208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B448Medicare Oscar/Certification
TXD47923Medicare UPIN