Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD60275601 | WA |
N | 208000000X | Pediatrician | MD60275601 | WA |
NPI | 1003070293 |
---|---|
Provider Name | Dr. James Toliver Bennett JR. |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/04/2014 |