Provider Demographics
NPI:1508933003
Name:BENTLEY, TERRY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WAYNE
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3428
Mailing Address - Country:US
Mailing Address - Phone:205-384-0141
Mailing Address - Fax:205-384-0171
Practice Address - Street 1:20 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3428
Practice Address - Country:US
Practice Address - Phone:205-384-0141
Practice Address - Fax:205-384-0171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL161282084P0800X
AL000161282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF26554Medicare UPIN