Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 0101267568 | VA |
NPI | 1962849786 |
---|---|
Provider Name | James Bennett |
First Address | Norfolk, VA 23502-4700 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 26/09/2019 |