Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 53762-021 | WI |
N | 111NI0900X | Internist | 53762-021 | WI |
Y | 207RH0002X | Hospice and Palliative Medicine | 53762-021 | WI |
NPI | 1144483439 |
---|---|
Provider Name | Dr. John Andrew Bennett |
First Address | Oshkosh, WI 54904-7668 |
Second Address | Oshkosh, WI 54904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 22/11/2021 |