1689668592 NPI number — DR. JEFFREY G BENTSON MD

Table of content: DR. JEFFREY G BENTSON MD (NPI 1689668592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689668592 NPI number — DR. JEFFREY G BENTSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTSON
Provider First Name:
JEFFREY
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689668592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BAL HARBOR BLVD
Provider Second Line Business Mailing Address:
UNIT 2302
Provider Business Mailing Address City Name:
PUNTA GORDA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33950-8229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-889-9264
Provider Business Mailing Address Fax Number:
941-505-6100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 BAL HARBOR BLVD
Provider Second Line Business Practice Location Address:
UNIT 2302
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33950-8229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-889-9264
Provider Business Practice Location Address Fax Number:
941-505-6100
Provider Enumeration Date:
09/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  44074 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: ME113951 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11014110 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR217A . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 591563145 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1851477913 . This is a "CMH NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 591563145 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 34194200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14NPI . This is a "BC/BS OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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