| Doctor Name: | DR. JOHN LOGAN BENNION |
| NPI Number: | 1689916470 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 28087 |
| Business Practice Address: | Whmc/ge-2200 2200 Bergquist Dr. Ste 1 Jbsa Lackland Afb, TX - 782365300 |
| Business Phone Number: | 2109165545 |
| Business Fax Number: | |
| Mailing Address: | 10619 Buck Park, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782453450 |
| Phone Number: | 2105719884 |
| Fax Number: | |
| NPI Enumeration Date: | 03/20/2013 |
| NPI Last Update Date: | 11/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 28087 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |