Provider Demographics
NPI:1417937434
Name:BENTLEY, FREDERICK R (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:BENTLEY
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 1:4301 W MARKHAM ST
Mailing Address - Street 2:#520
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-7428
Mailing Address - Fax:501-686-5696
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:#520
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-7428
Practice Address - Fax:501-686-5696
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4900208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00355164OtherRAILROAD MEDICARE
AR5N651OtherBLUE CROSS BLUE SHIELD
AR06090017000OtherQUALCHOICE
AR5N6516884OtherADDITIONAL MEDICARE
ARCQ2164OtherADDITIONAL RAILROAD MCARE
KY64250665Medicaid
ARE4900OtherTRICARE
ARCQ2164OtherADDITIONAL RAILROAD MCARE
C67951Medicare UPIN
KY1275047Medicare ID - Type Unspecified