Individual
JUSTIN DAVID BENNET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
1505 SOQUEL DR, SUITE12, SANTA CRUZ, CA 95065-1716
(831) 713-5050
(831) 475-0101
Mailing address
1505 SOQUEL DR, SUITE 12, SANTA CRUZ, CA 95065-1716
(831) 713-5050
(831) 475-0101
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
0101840379
VA
207RI0008X
Hepatology Physician
0101840379
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005847958
—
VA
Enumeration date
11/08/2006
Last updated
06/15/2012
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