Individual
MARK BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
777 MURPHY RD, MEDFORD, OR 97504-8425
(541) 772-2763
(541) 734-3164
Mailing address
777 MURPHY RD, MEDFORD, OR 97504-8425
(541) 772-2763
(541) 734-3164
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10011034
OR
Other
Enumeration date
10/22/2025
Last updated
10/22/2025
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