Provider Demographics
NPI:1083850820
Name:JEFFREY G. BENTSON, M.D., PLLC
Entity Type:Organization
Organization Name:JEFFREY G. BENTSON, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BENTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-0984
Mailing Address - Street 1:4161 TAMIAMI TRL
Mailing Address - Street 2:UNIT 101
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-625-0984
Mailing Address - Fax:941-625-0877
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:UNIT 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-625-0984
Practice Address - Fax:941-625-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty