Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000029 | WA |
N | 222Z00000X | Podiatrist | OI00000029 | WA |
N | 224P00000X | Prosthetist | PS00000028 | WA |
NPI | 1356300065 |
---|---|
Provider Name | Mr. Henry Lawrence Bennett |
First Address | Spokane, WA 99202-1313 |
Second Address | Spokane, WA 99202-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP001757 | AMERICAN BOARD FOR CERT O (01) |