Provider Demographics
NPI:1922034529
Name:BENTLEY, RONALD W (CRNA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:W
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 S CORIA ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7507
Mailing Address - Country:US
Mailing Address - Phone:956-544-7420
Mailing Address - Fax:
Practice Address - Street 1:1040 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6338
Practice Address - Country:US
Practice Address - Phone:956-698-5400
Practice Address - Fax:956-698-5713
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531308367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D4080Medicare ID - Type Unspecified