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NPI Code Detail

MEDICARE: RONALD LYNN BENNETT PA-C

MEDICARE: RONALD LYNN BENNETT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant685OK

General Provider Information

NPI Number : 1437129020
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD LYNN BENNETT PA-C
Provider Business Mailing Address
First Line : 5721 NW 132ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-4437
Country : US
Telephone Number : 405-557-1200
Fax Number : 405-557-1977
Provider Business Practice Location Address
First Line : 5721 NW 132ND ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73142-4437
Country : US
Telephone Number : 405-557-1200
Fax Number : 405-557-1977
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 02/21/2024

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Directions to “ RONALD LYNN BENNETT PA-C” Practice Location

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