Provider Demographics
NPI:1104885011
Name:BENTZEL, GREGORY N (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:N
Last Name:BENTZEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29652-1958
Mailing Address - Country:US
Mailing Address - Phone:864-879-3888
Mailing Address - Fax:864-801-3272
Practice Address - Street 1:105 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1737
Practice Address - Country:US
Practice Address - Phone:864-879-3888
Practice Address - Fax:864-801-3272
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD0706Medicaid
SCPD0706Medicaid