Healthcare Provider Details

I. General information

NPI: 1629807748
Provider Name (Legal Business Name): CARROLL GENE BENTLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S NATIONAL AVE STE 700
SPRINGFIELD MO
65807-5279
US

IV. Provider business mailing address

3800 S NATIONAL AVE STE 700
SPRINGFIELD MO
65807-5279
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-8817
  • Fax:
Mailing address:
  • Phone: 417-269-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025021649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: