Provider Demographics
NPI:1336501022
Name:GLADDEN, BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:
Last Name:GLADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BENNETT
Other - Middle Name:
Other - Last Name:ZUKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2307
Mailing Address - Country:US
Mailing Address - Phone:509-474-4049
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-474-3260
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60927879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60927879OtherWA STATE DEPT OF HEALTH