Individual
RANDALL PAUL BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
104 27TH AVE SE, PUYALLUP, WA 98374-1145
(253) 770-9000
(253) 770-9712
Mailing address
PO BOX 1205, PUYALLUP, WA 98371-0231
(253) 770-9000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD22922
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7078017
—
WA
Enumeration date
07/03/2006
Last updated
10/20/2015
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