Individual
BASIL BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
174 LMAH CENTER RD, LOGAN, WV 25601-4058
(304) 792-7130
(304) 896-5184
Mailing address
PO BOX 176, LOGAN, WV 25601-0176
(304) 792-7130
(304) 896-5184
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
0072
WV
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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