Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 23368 | KY |
NPI | 1013991165 |
---|---|
Provider Name | Donald Walter Bennett |
First Address | Louisville, KY 40215-1179 |
Second Address | Louisville, KY 40215-1179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200101170 | (05) | IN |
64233687 | (05) | KY |
C76151 | (02) |