Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 102881 | MO |
Y | 208200000X | Surgeon | 102881 | MO |
Y | 208600000X | Surgeon | 102881 | MO |
N | 2086S0102X | Surgical Critical Care | MC-0858 | ID |
NPI | 1326252545 |
---|---|
Provider Name | Ashley W Bennett |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 28/04/2021 |