| Randall Bentley Do Pa | |
|
6201 Overton Ridge Blvd Fort Worth TX 76132-3613 | |
| (817) 558-6695 | |
| (817) 301-6650 |
| Full Name | Randall Bentley Do Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 6201 Overton Ridge Blvd, Fort Worth, Texas |
| Authorized Official Name and Position | Evert R Bentley (PRESIDENT) |
| Authorized Official Contact | 8175586695 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall Bentley Do Pa Po Box 810 Joshua TX 76058-0810 Ph: (817) 558-6695 | Randall Bentley Do Pa 6201 Overton Ridge Blvd Fort Worth TX 76132-3613 Ph: (817) 558-6695 |
| NPI Number | 1043512288 |
|---|---|
| Provider Enumeration Date | 11/19/2010 |
| Last Update Date | 08/25/2011 |
| Medicare PECOS PAC ID | 3375727654 |
|---|---|
| Medicare Enrollment ID | O20110411000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043512288 | NPI | - | NPPES |
| 0025WC | Other | TX | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Evert R Bentley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093793226 PECOS PAC ID: 6305882267 Enrollment ID: I20050630000351 |
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