Provider Demographics
NPI:1316919855
Name:BENTLEY, ANTHONY A (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E WALNUT LAWN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7506
Mailing Address - Country:US
Mailing Address - Phone:417-875-3000
Mailing Address - Fax:417-875-3625
Practice Address - Street 1:960 E WALNUT LAWN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7506
Practice Address - Country:US
Practice Address - Phone:417-875-3000
Practice Address - Fax:417-875-3625
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016752207Y00000X
IL36115475207Y00000X
IN02002288A207Y00000X
ARE5699207Y00000X
MO2010011172207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204238802Medicaid
AR175626003Medicaid