Provider Demographics
NPI:1558709121
Name:BENTLEY, GARRETT A (DO)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:A
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2963 W WHITE MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-6257
Mailing Address - Country:US
Mailing Address - Phone:928-537-5437
Mailing Address - Fax:928-537-5857
Practice Address - Street 1:2550 ADDISON AVE E STE B
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6748
Practice Address - Country:US
Practice Address - Phone:208-814-8000
Practice Address - Fax:208-933-9301
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11017199A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine