Individual
DR. BROCK TANNER BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 MEDICAL CENTER DR STE 300, MEDFORD, OR 97504-4316
(541) 930-8907
(541) 245-4820
Mailing address
520 MEDICAL CENTER DR STE 300, MEDFORD, OR 97504-4316
(541) 930-8907
(541) 245-4820
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD218720
OR
2086S0129X
Vascular Surgery Physician
Primary
MD218720
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/07/2017
Last updated
07/25/2024
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