Provider Demographics
NPI:1801820329
Name:BENNETT, JOSEPH ROBINSON (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBINSON
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2828 CASA ALOMA WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2266
Mailing Address - Country:US
Mailing Address - Phone:407-673-9992
Mailing Address - Fax:407-673-9902
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2223
Practice Address - Country:US
Practice Address - Phone:407-673-9992
Practice Address - Fax:407-673-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0003899208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery