Healthcare Provider Details

I. General information

NPI: 1205161569
Provider Name (Legal Business Name): MR. COY BENTRY SIDNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 CRESCENT BRIDGE CT
HUMBLE TX
77396-1685
US

IV. Provider business mailing address

7310 CRESCENT BRIDGE CT
HUMBLE TX
77396-1685
US

V. Phone/Fax

Practice location:
  • Phone: 713-530-0935
  • Fax: 281-459-3386
Mailing address:
  • Phone: 713-530-0935
  • Fax: 281-459-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: