Individual
MATTHEW RAY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
560 S MAPLE ST, SUITE 200, WACONIA, MN 55387-1733
(952) 442-2163
(952) 442-5903
Mailing address
4200 DAHLBERG DR, SUITE 300, GOLDEN VALLEY, MN 55422-4840
(952) 512-5600
(952) 512-5651
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2193
MN
Other
Enumeration date
05/30/2014
Last updated
01/09/2015
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