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1811235419

NPI Code Detail

MEDICARE: ZACHARY D BENNER

MEDICARE: ZACHARY D BENNER

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
1	363A00000X	Physician Assistant	PA0000002770	TN
2	363A00000X	Physician Assistant	PA9107032	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811235419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY D BENNER

Provider Business Mailing Address
First Line	:	3401 FAWNWOOD PL
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2182
Country	:	US
Telephone Number	:	419-296-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 ADAMS LN STE 18
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-8320
Country	:	US
Telephone Number	:	615-453-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	03/05/2019

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Directions to “ ZACHARY D BENNER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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