Provider Demographics
NPI:1124180120
Name:BENT TREE FAMILY PHYSICIAN, PA
Entity Type:Organization
Organization Name:BENT TREE FAMILY PHYSICIAN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CULPEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-380-7000
Mailing Address - Street 1:17110 DALLAS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1167
Mailing Address - Country:US
Mailing Address - Phone:972-380-7000
Mailing Address - Fax:972-380-9266
Practice Address - Street 1:17110 DALLAS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1167
Practice Address - Country:US
Practice Address - Phone:972-380-7000
Practice Address - Fax:972-380-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018AZMedicare ID - Type UnspecifiedGROUP NUMBER