Provider Demographics
NPI:1134125008
Name:BENTCH, HERMAN LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:LEONARD
Last Name:BENTCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N BOWIE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3215
Mailing Address - Country:US
Mailing Address - Phone:830-990-9507
Mailing Address - Fax:
Practice Address - Street 1:205 N. BOWIE ST.
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3215
Practice Address - Country:US
Practice Address - Phone:830-990-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9359207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079590801Medicaid
00025FMedicare ID - Type Unspecified
D33379Medicare UPIN