Provider Demographics
NPI:1962499327
Name:BENNETT, IRA (DPM)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 WELLNESS LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5357
Mailing Address - Country:US
Mailing Address - Phone:727-848-3433
Mailing Address - Fax:727-376-4141
Practice Address - Street 1:1810 WELLNESS LN
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-5357
Practice Address - Country:US
Practice Address - Phone:727-848-3433
Practice Address - Fax:727-376-4141
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55396Medicare UPIN
FL480907215Medicare PIN
FL87270Medicare PIN