Provider Demographics
NPI:1144483439
Name:BENNETT, JOHN ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:855 N WESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7668
Mailing Address - Country:US
Mailing Address - Phone:920-303-3266
Mailing Address - Fax:920-456-5590
Practice Address - Street 1:855 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904
Practice Address - Country:US
Practice Address - Phone:920-303-3266
Practice Address - Fax:920-456-5590
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2021-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI53762-021207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine