Provider Demographics
NPI:1396759791
Name:BENNETT, JOE MARTIN (DO)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:MARTIN
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 1:1708 SOUTH LAFAYETTE
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-7542
Mailing Address - Country:US
Mailing Address - Phone:660-826-6633
Mailing Address - Fax:660-826-6440
Practice Address - Street 1:1708 SOUTH LAFAYETTE
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-7542
Practice Address - Country:US
Practice Address - Phone:660-826-6633
Practice Address - Fax:660-826-6440
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28757207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07123014OtherBCBS
MO07123014OtherBCBS
C49960Medicare UPIN