Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 11277589-1205 | UT |
Y | 207RI0011X | Interventional Cardiology | 11277589-1205 | UT |
NPI | 1013200997 |
---|---|
Provider Name | Daniel N. Bennett |
First Address | Provo, UT 84604-3305 |
Second Address | Provo, UT 84604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 24/03/2020 |