Individual
DR. JONATHAN JAMES BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
313 TERRITORIAL ST E, WATERTOWN, MN 55388-9284
(952) 955-1921
Mailing address
424 MN-5, WACONIA, MN 55387
(952) 442-4461
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
71173
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2019
Last updated
12/20/2023
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