Individual
DR. BENTLEY JORDAN BOBROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1133 JOHN FREEMAN BLVD # 270, HOUSTON, TX 77030-2809
(713) 500-7863
Mailing address
1133 JOHN FREEMAN BLVD # 270, HOUSTON, TX 77030-2809
(713) 500-7863
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21017
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170449
—
AZ
01
—
86080015085259C277
TRIWEST
AZ
01
—
930118000
RAILROAD MEDICARE
AZ
Enumeration date
11/17/2005
Last updated
06/27/2022
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