Healthcare Provider Details

I. General information

NPI: 1689670523
Provider Name (Legal Business Name): JOHN B. BENTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 E CAMP LOWELL DR
TUCSON AZ
85712-1296
US

IV. Provider business mailing address

5949 N CAMINO DEL CONDE
TUCSON AZ
85718-4311
US

V. Phone/Fax

Practice location:
  • Phone: 520-618-6058
  • Fax: 520-325-0963
Mailing address:
  • Phone: 520-299-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11621
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: