Provider Demographics
NPI:1518906825
Name:BENNETT, ROBERT DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
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 1:300 N HIGHLAND AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7389
Mailing Address - Country:US
Mailing Address - Phone:903-957-0082
Mailing Address - Fax:903-957-0351
Practice Address - Street 1:300 N HIGHLAND AVE STE 315
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7389
Practice Address - Country:US
Practice Address - Phone:903-957-0082
Practice Address - Fax:903-957-0351
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047496L208600000X
MS28320208G00000X
TXN0642208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA106030Medicare PIN
TXTXB164781Medicare PIN
E71518Medicare UPIN
TXTXB164782Medicare PIN
TXTXB164784Medicare PIN