MEDICARE: DR. BENTLEY JORDAN BOBROW M.D.

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	207P00000X	Emergency Medicine Physician	21017	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	930118000	OTHER	AZ	RAILROAD MEDICARE

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	86080015085259C277	OTHER	AZ	TRIWEST

General Provider Information

NPI Number	:	1528040276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENTLEY JORDAN BOBROW M.D.

Provider Business Mailing Address
First Line	:	1133 JOHN FREEMAN BLVD # 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2809
Country	:	US
Telephone Number	:	713-500-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 JOHN FREEMAN BLVD # 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2809
Country	:	US
Telephone Number	:	713-500-7863
Fax Number	:

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	06/27/2022

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