Provider Demographics
NPI:1205830536
Name:BENDFELDT, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:BENDFELDT
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:PO BOX 5725
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5725
Mailing Address - Country:US
Mailing Address - Phone:423-283-8801
Mailing Address - Fax:423-282-4533
Practice Address - Street 1:101 MED TECH PKWY
Practice Address - Street 2:STE 407
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4000
Practice Address - Country:US
Practice Address - Phone:423-283-8801
Practice Address - Fax:423-282-4533
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD091952084N0400X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA219709OtherTRIGON BC/BS
GA260046091OtherPALMETTO GBA
TN621837879-0002OtherCIGNA HEALTH CARE
TN3036274Medicaid
IL621837879-01OtherJOHN DEERE HEALTH CARE
VA7104511OtherMEDICAID VA7104511
TN1205830536Medicaid
TN3159564OtherBLUE CROSS BLUE SHIELD OF
TN421837879OtherCARITEN SENIOR HEALTH
NJ621837879OtherAIG CLAIM SVS WORKER COM
UT621837879OtherINITED HEALTH CARE
NC621837879OtherCM ADMINISTRATORS IN
NC621837879OtherCBHA CAROLINA BEHAVIORAL
FL621837879OtherHORIZON HEALTH
FL621837879OtherAMERICAN GENERAL LIFE
IL621837879OtherBANKERS LIFE
TNNPIMedicaid
MO21699743OtherGEHA
TN1205830536OtherNPI
TN621837870OtherUNITED BEHAVIORAL HEALTH
TN621837879OtherCONTINENTAL LIFE
NJ621837879OtherAIG CLAIM SVS WORKER COM
UT621837879OtherINITED HEALTH CARE
TNNPIMedicaid