Provider Demographics
NPI:1164494506
Name:RADFORD, BENNETT L (DO)
Entity Type:Individual
Prefix:PROF
First Name:BENNETT
Middle Name:L
Last Name:RADFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 E CRAWFORD ST
Mailing Address - Street 2:WEST BUILDING
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5103
Mailing Address - Country:US
Mailing Address - Phone:785-827-7261
Mailing Address - Fax:785-822-3095
Practice Address - Street 1:737 E CRAWFORD ST
Practice Address - Street 2:WEST BUILDING
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5103
Practice Address - Country:US
Practice Address - Phone:785-827-7261
Practice Address - Fax:785-822-3095
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25562207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100302190CMedicaid
KS106603OtherMEDICARE ID#
KS106603OtherMEDICARE ID#