Provider Demographics
NPI:1063499556
Name:BENTLIF, PHILIP S (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:BENTLIF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4346
Mailing Address - Street 2:DEPT 142
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:713-526-5511
Mailing Address - Fax:713-520-4705
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-526-5511
Practice Address - Fax:713-520-4705
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXC8898207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21205Medicare UPIN
TX819834Medicare PIN