Individual
EVERT RANDALL BENTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2660
(817) 735-5441
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2660
(817) 735-5441
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G7997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135596811
—
TX
01
—
8X7296
BCBS
TX
01
—
P00784416
RAILROAD MEDICARE
TX
Enumeration date
01/06/2006
Last updated
02/19/2010
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