Most Relevant Information
Provider Data
| NPI Number: | 1003479171 |
| Provider Name: | JONATHAN JAMES BENNETT MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/15/2019 |
| Last Updated: | 12/20/2023 |
Provider Practice Location
313 TERRITORIAL ST E
WATERTOWN
MN
553889284
Practice Location Phone/Fax
| Phone: | 9529551921 |
| Fax: |
Provider Mailing Location
424 MN-5
WACONIA
MN
55387
Provider Mailing Phone/Fax
| Phone: | 9524424461 |
| Fax: |