Paul A Bennett, MD
Family Medicine in Carbondale, IL. Individual provider (NPI-1).
NPI number1366526600
StatusActive
Last updated in NPPESMay 10, 2024
Details
- NPI
- 1366526600
- Entity type
- Individual (NPI-1)
- Name
- Paul A Bennett
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 24, 2006
- Certification date
- May 10, 2024
- Last updated
- May 10, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 036-054875 | IL | Yes |
Practice location
374 E Grand Ave # 6740Carbondale, IL 62901-3962
Phone 618-453-3311 · Fax 618-453-4449
Mailing address
3050 Chautauqua RdCarbondale, IL 62901-5241
Phone 618-457-5980
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