Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R71657 | AZ |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 58274 | AZ |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 8927677-1205 | UT |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD2015-0397 | NM |
NPI | 1306076294 |
---|---|
Provider Name | David Bennett |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Gilbert, AZ 85297-0423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2009 |
Last Update Date | 09/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113628 | (05) | AZ |