Provider Demographics
NPI:1144205899
Name:BENNETT, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
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 1:2804 DR JOHN HAYNES DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1438
Mailing Address - Country:US
Mailing Address - Phone:205-338-6655
Mailing Address - Fax:205-338-6658
Practice Address - Street 1:2804 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1438
Practice Address - Country:US
Practice Address - Phone:205-338-6655
Practice Address - Fax:205-338-6658
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00015383207P00000X
AL15383207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000046345Medicaid
AL000051302Medicaid
AL51051302OtherBLUE CROSS BLUE SHIELD
AL515-50606OtherBC BS OF AL
AL051550606Medicaid
AL51046345OtherBLUE CROSS BLUE SHIELD
AL137875Medicaid
AL051051302OtherBCBS PROVIDER NUMBER
AL051557203Medicaid
AL51545536OtherBLUE CROSS BLUE SHIELD
AL51051302OtherBLUE CROSS BLUE SHIELD
AL000046345Medicaid
AL050071262Medicare PIN
E46996Medicare UPIN
AL051557203Medicaid
AL051550606Medicaid
AL051550606Medicare PIN
AL000051302Medicare PIN