DR. BROCK TANNER BENNETT MD NPI 1578092193

NPI Information

  • NPI: 1578092193
  • Provider Name: DR. BROCK TANNER BENNETT, MD
  • Classification: Surgery - 2086S0129X
  • Specialization: Vascular Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 520 MEDICAL CENTER DR STE 300
    MEDFORD, OR
    ZIP 97504
  • Phone: (541) 930-8907

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NPI Details

DR. Brock Tanner Bennett, MD is a vascular surgery surgery in Medford, OR with 9 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. Brock Tanner Bennett, MD NPI is 1578092193. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE - PHOENIX
Graduation Year:2017

The provider's business location address is:

520 MEDICAL CENTER DR STE 300
MEDFORD, OR
ZIP 97504-316
Phone: (541) 930-8907
Fax: (541) 245-4820

The NPI 1578092193 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/7/2017 and was last updated on 7/25/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1390200000XStudent in an Organized Health Care Education/Training ProgramNo
22086S0129XSurgeryVascular SurgeryMD218720OREGONYes
3208600000XSurgeryMD218720OREGONNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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