Provider Demographics
NPI:1992889612
Name:BENNET, JOSEPH K (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:BENNET
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S UNION AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1322
Mailing Address - Country:US
Mailing Address - Phone:253-954-3354
Mailing Address - Fax:
Practice Address - Street 1:2420 S UNION AVE, SUITE 120
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1322
Practice Address - Country:US
Practice Address - Phone:253-954-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034685208M00000X, 207R00000X
TXK3987207R00000X
AZ68890207R00000X
OH35C.000345207R00000X
NV23263207R00000X
COCDR.0002403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8211971Medicaid
WA8211971Medicaid