Provider Demographics
NPI:1689668592
Name:BENTSON, JEFFREY G (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:G
Last Name:BENTSON
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 1:9300 DEWITT LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:757-836-1552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113951207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014110Medicaid
FLGR217AOtherMEDICARE
591563145OtherCIGNA
1851477913OtherCMH NPI
591563145OtherHUMANA
WI34194200Medicaid
FL14NPIOtherBC/BS OF FLORIDA
FL14NPIOtherBC/BS OF FLORIDA
1851477913OtherCMH NPI
WI00439Medicare PIN