Individual
BRUCE WAYNE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10507 E 91ST ST STE 510, TULSA, OK 74133-5462
(918) 307-5525
(918) 307-5526
Mailing address
6600 S YALE AVE, STE 1400, TULSA, OK 74136-3331
(918) 307-5525
(918) 307-5526
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15660
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107490A
—
OK
Enumeration date
03/16/2006
Last updated
04/22/2021
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