Provider Demographics
NPI:1174817258
Name:BENTLEY, ROGER BOYD JR (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:BOYD
Last Name:BENTLEY
Suffix:JR
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:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-252-1977
Mailing Address - Fax:
Practice Address - Street 1:212 E CENTRAL AVE STE 440
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6290
Practice Address - Country:US
Practice Address - Phone:509-252-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28551207X00000X
MT58882207X00000X
MTMED-PHYS-LIC-58882207X00000X
ORMD204587207X00000X
WAMD61180938207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery