Provider Demographics
NPI:1679782221
Name:BENNETT, RYAN N (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 SW ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4466
Mailing Address - Country:US
Mailing Address - Phone:785-270-0197
Mailing Address - Fax:
Practice Address - Street 1:2902 SW ASBURY DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4466
Practice Address - Country:US
Practice Address - Phone:785-270-0197
Practice Address - Fax:785-368-0474
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-34044207Q00000X
KS0534044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200629480AMedicaid
KS068002065OtherMEDICARE - PTAN