Individual
JOHN MELTON BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
209 PAULINE DR, BEREA, KY 40403-8889
(859) 233-4511
Mailing address
1101 VETERANS DR, BEREA CBOC, LEXINGTON, KY 40502-2235
(859) 233-4511
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
30690
KY
207Q00000X
Family Medicine Physician
Primary
30690
KY
207QA0000X
Adolescent Medicine (Family Medicine) Physician
30690
KY
207QA0505X
Adult Medicine Physician
30690
KY
207QG0300X
Geriatric Medicine (Family Medicine) Physician
30690
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64306905
—
KY
Enumeration date
06/26/2006
Last updated
04/03/2015
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