John Kelly Bennett, RT (R,CT)

Individual provider Active NPI Computed Tomography Radiologic Technologist · Trinity, FL

NPI 1710137583 · NPPES record last updated Sep 29, 2008

Key facts

NPI
1710137583
Entity type
Individual (NPI type 1)
Primary specialty
Computed Tomography Radiologic Technologist 2471C3401X
License
CRT52901 (FL)
Practice address
1661 Kinsmere Dr
Trinity, FL 34655-4528
Phone
(727) 236-5309
NPI assigned
Sep 29, 2008
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CRT52901FLMDComputed Tomography Radiologic Technologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Computed Tomography Radiologic Technologist 2471C3401X CRT52901 FL Yes

Addresses

Primary practice location

1661 Kinsmere Dr
Trinity, FL 34655-4528

Mailing address

1661 Kinsmere Dr
Trinity, FL 34655-4528
Phone (727) 236-5309

Other providers in Trinity, FL

All providers in Trinity, FL · Computed Tomography Radiologic Technologist in Florida

Sources for this page

Verify at the official NPI Registry.