Provider Demographics
NPI:1972703445
Name:FIELDER, BENNY DEWAYNE (DR)
Entity Type:Individual
Prefix:MR
First Name:BENNY
Middle Name:DEWAYNE
Last Name:FIELDER
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 LYNNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-4414
Mailing Address - Country:US
Mailing Address - Phone:918-333-3592
Mailing Address - Fax:918-273-3432
Practice Address - Street 1:202 E GALER AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4422
Practice Address - Country:US
Practice Address - Phone:918-273-0192
Practice Address - Fax:918-273-3234
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3720403OtherNABP