Individual
DOUGLAS M. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 388-5432
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1791
WV
207R00000X
Internal Medicine Physician
1791
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1800032-000
—
WV
Enumeration date
08/13/2006
Last updated
04/16/2013
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