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Contact Information

RANDALL P BENNETT, MD
104 27TH AVE SE
PUYALLUP, WA98374-1145
 Phone: 253-770-9000
 Fax: 253-770-9712
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for RANDALL P BENNETT · (Male)

NPI Number 1619907953
Status Active
Credentials MD
Entity Individual
Enumeration date 07/03/2006
Last updated 10/20/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • WA License # MD22922
  • WA Medicaid 7078017
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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