Provider Demographics
NPI:1356352538
Name:GARNER, BENNETT W (MD)
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:W
Last Name:GARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 COMMERCIAL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4515
Mailing Address - Country:US
Mailing Address - Phone:503-325-8868
Mailing Address - Fax:503-325-9186
Practice Address - Street 1:818 COMMERCIAL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4515
Practice Address - Country:US
Practice Address - Phone:503-325-8868
Practice Address - Fax:503-325-9186
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119623Medicare ID - Type Unspecified