Provider Demographics
NPI:1124161922
Name:BENNETT, STANLEY HAROLD (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:HAROLD
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-0338
Mailing Address - Country:US
Mailing Address - Phone:507-831-1703
Mailing Address - Fax:507-832-8168
Practice Address - Street 1:PO BOX 338
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-0338
Practice Address - Country:US
Practice Address - Phone:507-831-1703
Practice Address - Fax:507-832-8168
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38102207Q00000X
MNMN38102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine