Provider Demographics
NPI:1285618629
Name:DONNA C. BENNETT, MD, PA
Entity type:Organization
Organization Name:DONNA C. BENNETT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-475-0007
Mailing Address - Street 1:4220 N DAVIS HWY
Mailing Address - Street 2:BUILDING A, SUITE 100
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2752
Mailing Address - Country:US
Mailing Address - Phone:850-475-0007
Mailing Address - Fax:850-475-1309
Practice Address - Street 1:4220 N DAVIS HWY
Practice Address - Street 2:BUILDING A, SUITE 100
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2752
Practice Address - Country:US
Practice Address - Phone:850-475-0007
Practice Address - Fax:850-475-1309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty