Provider Demographics
NPI:1801855853
Name:BENNETT, PAUL WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WESLEY
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7712 BRANDBURY PLACE
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-791-8266
Mailing Address - Fax:
Practice Address - Street 1:4151 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3617
Practice Address - Country:US
Practice Address - Phone:614-875-3152
Practice Address - Fax:614-875-0090
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49469207Q00000X
OH087031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA92905Medicare UPIN