Provider Demographics
NPI:1427585488
Name:BENDER, DANIEL MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MATTHEW
Last Name:BENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2291
Mailing Address - Country:US
Mailing Address - Phone:307-463-7160
Mailing Address - Fax:
Practice Address - Street 1:1035 ROSE LN
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2291
Practice Address - Country:US
Practice Address - Phone:307-233-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13005A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine