Provider Demographics
NPI:1215580204
Name:BEDFORD, DARREN VINCENT (CRT,RCP)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:VINCENT
Last Name:BEDFORD
Suffix:
Gender:M
Credentials:CRT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WASHINGTON CIR STE A
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-5718
Mailing Address - Country:US
Mailing Address - Phone:956-245-4115
Mailing Address - Fax:
Practice Address - Street 1:710 WASHINGTON CIR STE A
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-5718
Practice Address - Country:US
Practice Address - Phone:956-245-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP00078855332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies