Provider Demographics
NPI:1689668592
Name:BENTSON, JEFFREY G (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:BENTSON
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 1:2001 BAL HARBOR BLVD
Mailing Address - Street 2:UNIT 2302
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8229
Mailing Address - Country:US
Mailing Address - Phone:941-889-9264
Mailing Address - Fax:941-505-6100
Practice Address - Street 1:2001 BAL HARBOR BLVD
Practice Address - Street 2:UNIT 2302
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-8229
Practice Address - Country:US
Practice Address - Phone:941-889-9264
Practice Address - Fax:941-505-6100
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44074207X00000X
FLME113951207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014110Medicaid
FLGR217AOtherMEDICARE
591563145OtherCIGNA
1851477913OtherCMH NPI
591563145OtherHUMANA
WI34194200Medicaid
FL14NPIOtherBC/BS OF FLORIDA
FL14NPIOtherBC/BS OF FLORIDA
1851477913OtherCMH NPI
WI00439Medicare PIN