Provider Demographics
NPI:1497762926
Name:BENNETT, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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:PO BOX 35862
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5862
Mailing Address - Country:US
Mailing Address - Phone:520-742-2800
Mailing Address - Fax:520-544-5437
Practice Address - Street 1:1921 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7806
Practice Address - Country:US
Practice Address - Phone:520-742-2800
Practice Address - Fax:520-544-5437
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31767208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ884701Medicaid
0758440OtherBCBS OF AZ
P00142331OtherRAILROAD MEDICARE
AZ82158Medicare PIN
H69408Medicare UPIN