Provider Demographics
NPI:1912192816
Name:BENTLEY, KARL COBLENZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:COBLENZ
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KC
Other - Middle Name:
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1519 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6605
Mailing Address - Country:US
Mailing Address - Phone:956-968-3171
Mailing Address - Fax:956-968-5783
Practice Address - Street 1:1519 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6605
Practice Address - Country:US
Practice Address - Phone:956-968-3171
Practice Address - Fax:956-968-5783
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3491207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288357101Medicaid
TXP01004892OtherRAILROAD MEDICARE
TX288357101Medicaid