Individual
DR. PAUL JOHN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 NE RANDOLPH AVE, PEORIA, IL 61606-1919
(309) 683-8170
Mailing address
100 NE RANDOLPH AVE, PEORIA, IL 61606-1919
(309) 683-8170
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070019448
IL
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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