Basic Information
| Provider Information | |||||||||
| NPI: | 1669574588 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | GORDON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2475 N PARK DR | ||||||||
| Address2: | STE 10 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472032200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123737940 | ||||||||
| FaxNumber: | 8123789518 | ||||||||
| Practice Location | |||||||||
| Address1: | 2475 N PARK DR | ||||||||
| Address2: | STE 10 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472032200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123737940 | ||||||||
| FaxNumber: | 8123789518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.