Individual
MR. JACK DAVID BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
617 S MARKET ST, #2, WAVERLY, OH 45690-1654
(740) 941-1859
(740) 941-1859
Mailing address
617 S MARKET ST, #2, WAVERLY, OH 45690-1654
(740) 941-1859
(740) 941-1859
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35067134
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0986429
—
OH
Enumeration date
07/18/2007
Last updated
07/18/2007
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