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General NPI Number Information
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NPI Number | 1174817258
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Entity Type | Individual
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Provider Name | ROGER BOYD BENTLEY JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 212 E CENTRAL AVE STE 440
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City | SPOKANE
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State | WA
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Zip | 99208-6290
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Country | US
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Telephone | 509-252-1977
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 421
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-0421
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Country | US
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Telephone | 509-252-1977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 28551
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 58882
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MED-PHYS-LIC-58882
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD204587
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD61180938
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License Number State | WA
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