Individual
DR. KERRY D. BENNETT
Active
Individual
DR. KERRY D. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
02001168A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209731
ANTHEM PIN
IN
01
—
200043532
RR MEDICARE
IN
05
—
200359010
—
IN
Enumeration date
07/31/2006
Last updated
11/13/2023
Update your record
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