Provider Demographics
NPI:1982776944
Name:BENNETT, STEVEN PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PHILLIP
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:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9040 REID ST
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-1367
Mailing Address - Fax:253-968-2284
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-1367
Practice Address - Fax:253-968-2284
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047199207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
77385877OtherAETNA
WA216734OtherLABOR & INDUSTRIES
8918BEOtherREGENCE BLUE SHIELD
WA8472466Medicaid
WA8472466Medicaid
77385877OtherAETNA
WA216734OtherLABOR & INDUSTRIES
FB0114013OtherDEA
G8875330Medicare PIN
WAG8863418Medicare PIN
WA8472466Medicaid