Provider Demographics
NPI:1225075252
Name:BENTZ, PHILIP D (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:D
Last Name:BENTZ
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 30423
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1423
Mailing Address - Country:US
Mailing Address - Phone:850-471-0707
Mailing Address - Fax:850-478-7377
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:850-471-0707
Practice Address - Fax:850-478-7377
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009704180Medicaid
FL17433OtherBLUE CROSS BLUE SHIELD
FL050012460OtherRAILROAD MEDICARE
FLZ123OtherHEALTH FIRST NETWORK
FL038166700Medicaid
AL59020293OtherBLUE CROSS BLUE SHIELD
FLZ123OtherHEALTH FIRST NETWORK
FL038166700Medicaid