Provider Demographics
NPI:1790338994
Name:ROBERT J. BENTLEY LLC
Entity Type:Organization
Organization Name:ROBERT J. BENTLEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-1519
Mailing Address - Street 1:4960 RICE MINE RD NE STE 40
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2671
Mailing Address - Country:US
Mailing Address - Phone:205-759-1519
Mailing Address - Fax:205-750-8612
Practice Address - Street 1:4960 RICE MINE RD NE STE 40
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2671
Practice Address - Country:US
Practice Address - Phone:205-759-1519
Practice Address - Fax:205-750-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty