Individual
MS. RACHEL JOHANNA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
(503) 988-4167
Mailing address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD168554
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
05
—
500690415
—
OR
Enumeration date
10/30/2009
Last updated
02/05/2021
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