Provider Demographics
NPI:1073549895
Name:BENNIE, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:BENNIE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14055 RIVEREDGE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637-2141
Mailing Address - Country:US
Mailing Address - Phone:813-929-5451
Mailing Address - Fax:
Practice Address - Street 1:14055 RIVEREDGE DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637-2141
Practice Address - Country:US
Practice Address - Phone:813-929-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME985782085R0204X
FLME 985782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026660346OtherNY MEDICAID
NY769T51OtherNY MEDICARE