Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | BP10044151 | TX |
Y | 2086S0129X | Vascular Surgeon | MD60878025 | WA |
NPI | 1043579600 |
---|---|
Provider Name | Dr. Matthew Evans Bennett |
First Address | Seattle, WA 98101-2756 |
Second Address | Seattle, WA 98101-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2012 |
Last Update Date | 23/07/2020 |