1275704157 NPI number — DR. BENNETT WILLIAM MCALLISTER MD

Table of content: DR. BENNETT WILLIAM MCALLISTER MD (NPI 1275704157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275704157 NPI number — DR. BENNETT WILLIAM MCALLISTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCALLISTER
Provider First Name:
BENNETT
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275704157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 512139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33951-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-625-5895
Provider Business Mailing Address Fax Number:
941-629-1111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4161 TAMIAMI TRL STE 304D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-9254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-625-5895
Provider Business Practice Location Address Fax Number:
941-625-1047
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME104685 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH842Y . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017596500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114514100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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