Provider Demographics
NPI:1881659936
Name:BENNETT, SUZANNE MP (DO)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MP
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:BLDG H STE 144
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-843-2300
Mailing Address - Fax:602-843-2310
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG H STE 144
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1253
Practice Address - Country:US
Practice Address - Phone:602-843-2300
Practice Address - Fax:602-843-2310
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3258208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63285Medicare UPIN
AZ60272Medicare ID - Type Unspecified