Bennett, Jack David
Bennett, Jack David is an sole proprietor health care provider with primary practice located at 617 S Market St #2, Waverly OH 45690-1654. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Bennett, Jack David can be contacted via phone (740) 941-1859.Contact Information
Primary practice address
617 S Market St #2
Waverly OH 45690-1654
Phone: (740) 941-1859
Fax: (740) 941-1859
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 35067134 | Ohio |
Profile Details
| NPI number | 1518167550 |
|---|---|
| LBN Legal business name | Bennett, Jack David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 18th, 2007 |
| Last updated | Jul 18th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518167550 | NPPES |
| Ohio | MEDICAID | 0986429 |
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