Robert Joseph Bennett Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

13841 Issued in CO

Practice address

602 Yale PL
Canon City, CO 81212-4611

Phone

(719) 275-2301

Fax

(719) 275-7048

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kieca MD PLLC

  dba Grand Mesa Family Practice

  • Primary Care Clinic/Center
  • Delta, CO
  • NPI 1013103373
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302134400000",
    "number": "1053479402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 YALE PL",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124611",
            "telephone_number": "719-275-2301",
            "fax_number": "719-275-7048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 YALE PL",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124611",
            "telephone_number": "719-275-2301",
            "fax_number": "719-275-7048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "ROBERT",
        "middle_name": "JOSEPH",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2011-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "13841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01138411",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelley E Bell
• Brittany Nicole Bellino
• Jessica Lea Bena, MS
• Jordan Benis
• Caleb R Bennett
• Robin Bangasser Bentley, FNP-C
• Amy Bergant, MSW
• Patricia L Berndt, NP
• Demmi Berry
• Melanie Betts

• Family Medicine Physician in Canon City, CO
• Providers in Canon City, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.