Provider Demographics
NPI:1811216518
Name:BENNETT, ERWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:
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 1:4294 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3604
Mailing Address - Country:US
Mailing Address - Phone:334-274-9000
Mailing Address - Fax:334-274-0857
Practice Address - Street 1:6007 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4008
Practice Address - Country:US
Practice Address - Phone:334-274-9000
Practice Address - Fax:334-274-0857
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 35119207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51178870OtherBLUE CROSS PROVIDER NUMBER
AL51178870OtherBLUE CROSS PROVIDER NUMBER