Provider Demographics
NPI:1891713418
Name:BENNETT, PATRICK MULVEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MULVEY
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 1:1000 S. ELISEO DR
Mailing Address - Street 2:SUITE #201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-461-4000
Mailing Address - Fax:
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:SUITE #201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G783460OtherBLUE SHIELD
CA00G783460OtherBLUE SHIELD
CA00G783460Medicare ID - Type UnspecifiedMEDICARE