Provider Demographics
NPI:1548489677
Name:BENNETT, LAURA L (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:P.O. BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5128
Mailing Address - Fax:325-793-5139
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:STE 285
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:325-793-5128
Practice Address - Fax:325-793-5139
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2018-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL6287208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J7873Medicare PIN