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Organization
RANDALL BENTLEY DO PA
Active
Organization
RANDALL BENTLEY DO PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVERT R BENTLEY DO (PRESIDENT)
(817) 558-6695
Entity
Organization
Contact information
Practice address
6201 OVERTON RIDGE BLVD, FORT WORTH, TX 76132-3613
(817) 558-6695
(817) 301-6650
Mailing address
PO BOX 810, JOSHUA, TX 76058-0810
(817) 558-6695
(817) 301-6650
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025WC
BCBS
TX
Enumeration date
11/19/2010
Last updated
08/25/2011
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