Individual
DR. ANDREW LEON BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
896 FORTNER ST, ONTARIO, OR 97914-1787
(541) 881-2828
(541) 881-2880
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M-14113
ID
207Q00000X
Family Medicine Physician
MD00028532
WA
207Q00000X
Family Medicine Physician
Primary
MD217581
OR
Other
Enumeration date
10/21/2015
Last updated
08/30/2024
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