Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00038434 | WA |
NPI | 1093748964 |
---|---|
Provider Name | Martin A. Bennett |
First Address | Bremerton, WA 98310-4229 |
Second Address | Bremerton, WA 98310-4229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8253056 | (05) | WA |
H06876 | (02) | WA |