Provider Demographics
NPI:1689670523
Name:BENTLEY, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:BENTLEY
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 1:5949 N CAMINO DEL CONDE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4311
Mailing Address - Country:US
Mailing Address - Phone:520-299-0397
Mailing Address - Fax:
Practice Address - Street 1:4620 E CAMP LOWELL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1296
Practice Address - Country:US
Practice Address - Phone:520-618-6058
Practice Address - Fax:520-325-0963
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11621207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD36553Medicare UPIN
AZZ29273Medicare PIN