Provider Demographics
NPI:1558317362
Name:BENDER, BARRY (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:BENDER
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 1:1201 HWY 71 SOUTH
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747
Mailing Address - Country:US
Mailing Address - Phone:605-745-3159
Mailing Address - Fax:605-745-3957
Practice Address - Street 1:1201 HWY 71 SOUTH
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-3159
Practice Address - Fax:605-745-3957
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5648146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
E28941Medicare UPIN
SDE28941Medicare UPIN
SDS100703Medicare PIN