Provider Demographics
NPI:1912935917
Name:BENTLEY, JAMES RANDY
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RANDY
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MOBILE INFIRMARY CIR
Mailing Address - Street 2:STE 201
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3514
Mailing Address - Country:US
Mailing Address - Phone:251-435-7900
Mailing Address - Fax:251-435-6261
Practice Address - Street 1:3 MOBILE INFIRMARY CIR
Practice Address - Street 2:STE 201
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3514
Practice Address - Country:US
Practice Address - Phone:251-435-7900
Practice Address - Fax:251-435-6261
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9721174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51009597OtherMEDICARE
AL05525700001OtherCIGNA
AL51009597OtherBLUECROSS BLUESHIELD
AL528902340Medicaid
AL000009597Medicare PIN
AL528902340Medicaid