Provider Demographics
NPI:1568446995
Name:BENNETT, DONNA CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CHRISTINE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 OLD PETERMAN HWY
Mailing Address - Street 2:
Mailing Address - City:PETERMAN
Mailing Address - State:AL
Mailing Address - Zip Code:36471-4117
Mailing Address - Country:US
Mailing Address - Phone:352-293-5755
Mailing Address - Fax:
Practice Address - Street 1:1701 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1402
Practice Address - Country:US
Practice Address - Phone:251-300-9223
Practice Address - Fax:251-433-8840
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29459207V00000X
LA328645207V00000X
AL30226207V00000X
IAMD-45185207V00000X
TN55317207V00000X
FLME69253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL59010467OtherBLUE CROSS & BLUE SHIELD
FL27856OtherBLUE CROSS & BLUE SHIELD
G20586Medicare UPIN