Provider Demographics
NPI:1992688360
Name:BENNETT, JASON (RAD TECH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:RAD TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 MERCURY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8955
Mailing Address - Country:US
Mailing Address - Phone:970-252-3200
Mailing Address - Fax:
Practice Address - Street 1:27B TALISMAN DR UNIT 3276N1
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-7913
Practice Address - Country:US
Practice Address - Phone:970-252-3200
Practice Address - Fax:970-252-3200
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist