Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35-051526 | OH |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35.051526 | OH |
NPI | 1740240118 |
---|---|
Provider Name | Gordon Bennett |
First Address | Akron, OH 44333-8320 |
Second Address | Akron, OH 44333-8320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 18/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0823934 | (05) | OH |
200036198 | RAIL ROAD MEDICARE (01) | OH |