Individual
JOSEPH S BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
615 S 32ND ST, MUSKOGEE, OK 74401-5012
(918) 687-3994
(918) 687-1809
Mailing address
615 S 32ND ST, MUSKOGEE, OK 74401-5012
(918) 687-3994
(918) 687-1809
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
718
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100212410C
—
OK
Enumeration date
05/01/2006
Last updated
02/17/2010
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