Provider Demographics
NPI:1053840371
Name:BENNETT, ERIKA MARGARET (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:MARGARET
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:MARGARET
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4316
Mailing Address - Country:US
Mailing Address - Phone:541-930-8900
Mailing Address - Fax:541-245-4820
Practice Address - Street 1:520 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4316
Practice Address - Country:US
Practice Address - Phone:541-930-8907
Practice Address - Fax:541-245-4820
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD218722208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery