Healthcare Provider Details

I. General information

NPI: 1134125008
Provider Name (Legal Business Name): HERMAN LEONARD BENTCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. BOWIE ST.
FREDERICKSBURG TX
78624-3215
US

IV. Provider business mailing address

205 N BOWIE ST
FREDERICKSBURG TX
78624-3215
US

V. Phone/Fax

Practice location:
  • Phone: 830-990-9507
  • Fax:
Mailing address:
  • Phone: 830-990-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD9359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: