Provider Demographics
NPI:1083069264
Name:BENNETT, JEAN MARIE-REMONIDA (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE-REMONIDA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:60TH MEDICAL GROUP
Mailing Address - Street 2:101 BODIN CIRCLE, BUILDING 777
Mailing Address - City:TRAVIS AIR FORCE BASE
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1801
Mailing Address - Country:US
Mailing Address - Phone:707-423-5323
Mailing Address - Fax:707-423-7446
Practice Address - Street 1:60TH MEDICAL GROUP
Practice Address - Street 2:101 BODIN CIRCLE, BUILDING 777
Practice Address - City:TRAVIS AIR FORCE BASE
Practice Address - State:CA
Practice Address - Zip Code:94535-1801
Practice Address - Country:US
Practice Address - Phone:707-423-5323
Practice Address - Fax:707-423-7446
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101268030208000000X
TXBP10064829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics