Individual
ALYSHA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3377 RIVERBEND DR, SPRINGFIELD, OR 97477-8803
(541) 222-8500
(541) 222-6435
Mailing address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(541) 520-8116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD182796
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/14/2014
Last updated
11/22/2019
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