Provider Demographics
NPI:1306054614
Name:BENNETT, THOMAS BENTON (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BENTON
Last Name:BENNETT
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 1:3935 E VIA DEL RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-5816
Mailing Address - Country:US
Mailing Address - Phone:480-399-2511
Mailing Address - Fax:
Practice Address - Street 1:3935 E VIA DEL RANCHO RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-5816
Practice Address - Country:US
Practice Address - Phone:480-399-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1789207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology