Provider Demographics
NPI:1174853303
Name:BENNETT, GEORGE MARTIN (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARTIN
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 1:870 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-4235
Mailing Address - Country:US
Mailing Address - Phone:801-451-7091
Mailing Address - Fax:801-451-7091
Practice Address - Street 1:870 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-4235
Practice Address - Country:US
Practice Address - Phone:801-451-7091
Practice Address - Fax:801-451-7091
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150464-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology