Individual
BRYAN ANDREW BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 ROE AVE, ELMIRA, NY 14905-1629
(607) 442-1713
Mailing address
813 CANTON ST, TROY, PA 16947-1452
(801) 520-6994
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD61400314
WA
Other
Enumeration date
04/24/2020
Last updated
03/06/2023
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