Provider Demographics
NPI:1598313165
Name:BENDER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BENDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16970 CAROLYN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3818
Mailing Address - Country:US
Mailing Address - Phone:239-940-4500
Mailing Address - Fax:
Practice Address - Street 1:16970 CAROLYN LN
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3818
Practice Address - Country:US
Practice Address - Phone:239-940-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider