Provider Demographics
NPI:1396739637
Name:BENNION, JAMES ROALD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROALD
Last Name:BENNION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:79 MDG CHIEF, MEDICAL STAFF
Mailing Address - Street 2:1050 WEST PERIMETER RD
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762-6601
Mailing Address - Country:US
Mailing Address - Phone:240-857-8811
Mailing Address - Fax:
Practice Address - Street 1:79 MDG CHIEF, MEDICAL STAFF
Practice Address - Street 2:1050 WEST PERIMETER RD
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-8811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-60042083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine