Provider Demographics
NPI:1184731283
Name:ABE, BENNETT K (MD)
Entity type:Individual
Prefix:
First Name:BENNETT
Middle Name:K
Last Name:ABE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S COURT ST STE F
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4931
Mailing Address - Country:US
Mailing Address - Phone:559-734-9244
Mailing Address - Fax:559-734-6932
Practice Address - Street 1:1700 S COURT ST STE F
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4931
Practice Address - Country:US
Practice Address - Phone:559-734-9244
Practice Address - Fax:559-734-9244
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA716882085R0202X, 2085R0204X
CARHL001659252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100511830Medicaid
NV222452OtherWC
NVCC6103OtherBCBS
NV222453OtherWC
NVCC6103OtherBCBS
OKH85322Medicare UPIN
NVP00391389Medicare PIN
NV100511830Medicaid