Individual
JEFFERY RUSTEN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
316 CALHOUN ST, ATTN: RADIOLOGY DEPARTMENT, CHARLESTON, SC 29401-1113
(843) 724-2000
Mailing address
PO BOX 2363, INDIANAPOLIS, IN 46206-2363
(843) 724-2154
(317) 663-6054
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2004-00341
NC
2085R0202X
Diagnostic Radiology Physician
Primary
29827
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298270
—
SC
01
—
P00403138
RR MCARE
SC
Enumeration date
07/28/2006
Last updated
02/13/2014
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