MEDICARE: DR. BRENT ALAN BENDER DPM

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	213E00000X	Podiatrist	1423	TX

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

General Provider Information

NPI Number	:	1912934654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT ALAN BENDER DPM

Provider Business Mailing Address
First Line	:	707 N ZANG BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4337
Country	:	US
Telephone Number	:	214-946-3668
Fax Number	:	214-943-5130

Provider Business Practice Location Address
First Line	:	630 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4335
Country	:	US
Telephone Number	:	214-946-3668
Fax Number	:	214-943-5130

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/15/2019

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