Basic Information
| Provider Information | |||||||||
| NPI: | 1649241886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNER | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 UPPER RAGSDALE DR | ||||||||
| Address2: | STE B230 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939407853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316490808 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 UPPER RAGSDALE DR | ||||||||
| Address2: | B230 | ||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316491000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G41631 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.