Individual
JOHN A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8208 LOUISIANA BLVD NE, STE C, ALBUQUERQUE, NM 87113-1757
(505) 858-1222
(505) 858-1224
Mailing address
8208 LOUISIANA BLVD NE, STE C, ALBUQUERQUE, NM 87113-1757
(505) 858-1222
(505) 858-1224
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
70-104
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02980
—
NM
Enumeration date
10/25/2006
Last updated
05/20/2016
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