Provider Demographics
NPI:1275704157
Name:MCALLISTER, BENNETT WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:WILLIAM
Last Name:MCALLISTER
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:PO BOX 512139
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-2139
Mailing Address - Country:US
Mailing Address - Phone:941-625-5895
Mailing Address - Fax:941-629-1111
Practice Address - Street 1:4161 TAMIAMI TRL STE 304D
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9254
Practice Address - Country:US
Practice Address - Phone:941-625-5895
Practice Address - Fax:941-625-1047
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1046852084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH842YOtherMEDICARE PTAN
FL017596500Medicaid
FL114514100Medicaid