Provider Demographics
NPI:1255355467
Name:BENNETT, DANIEL S (MD, DABPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD, DABPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14828 W 6TH AVE
Mailing Address - Street 2:STE 16-B
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5000
Mailing Address - Country:US
Mailing Address - Phone:720-541-6800
Mailing Address - Fax:720-541-6801
Practice Address - Street 1:14828 W 6TH AVE
Practice Address - Street 2:STE 16-B
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5000
Practice Address - Country:US
Practice Address - Phone:720-541-6800
Practice Address - Fax:720-541-6801
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31118207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF67232Medicare UPIN