Provider Demographics
NPI:1104087592
Name:BENETT, DONALD (DO)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:BENETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731327
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-1327
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 731327
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32173-1327
Practice Address - Country:US
Practice Address - Phone:386-677-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2018-05-23
Deactivation Date:2010-01-26
Deactivation Code:
Reactivation Date:2018-05-23
Provider Licenses
StateLicense IDTaxonomies
FLOS5141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine