Doctor Name: | WILLIAM RUSSELL MURRAY BENNETT |
NPI Number: | 1568542462 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | C55097 |
Business Practice Address: | 1000 Vale Terrace Dr Vista, CA - 920845218 |
Business Phone Number: | 7606315000 |
Business Fax Number: | 7604143702 |
Mailing Address: | 1000 Vale Terrace Dr, VISTA |
State: | CA |
Postal Code: | 920845218 |
Phone Number: | 7606315000 |
Fax Number: | 7604143702 |
NPI Enumeration Date: | 10/16/2006 |
NPI Last Update Date: | 03/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | C55097 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |