Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1457837403 |
---|---|
Provider Name | Mr. Miles S Bennett |
First Address | Portland, OR 97239-2964 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2018 |
Last Update Date | 12/07/2018 |