MEDICARE: ANTHONY A BENTLEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	E5699	AR
2	207Y00000X	Otolaryngology Physician	36115475	IL
3	207Y00000X	Otolaryngology Physician	2010011172	MO
4	207Y00000X	Otolaryngology Physician	02002288A	IN
5	207Y00000X	Otolaryngology Physician	5101016752	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316919855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY A BENTLEY D.O.

Provider Business Mailing Address
First Line	:	1001 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5155
Country	:	US
Telephone Number	:	417-875-3000
Fax Number	:	417-875-3625

Provider Business Practice Location Address
First Line	:	1001 E PRIMROSE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-5155
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	09/30/2025

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Directions to “ ANTHONY A BENTLEY D.O.” Practice Location

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