Individual
DIANA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 285-9321
Mailing address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD00034600
WA
207W00000X
Ophthalmology Physician
Primary
MD15309
OR
Other
Enumeration date
10/02/2006
Last updated
07/13/2007
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