Individual
JONATHAN DAVID BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-5051
(804) 828-7748
(804) 827-0285
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101263870
VA
2086S0102X
Surgical Critical Care Physician
0101263870
VA
2086S0127X
Trauma Surgery Physician
0101263870
VA
Other
Enumeration date
05/31/2012
Last updated
09/13/2021
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