Provider Demographics
NPI:1396718128
Name:BENTZ, WILLIAM JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BENTZ
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 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-353-4101
Mailing Address - Fax:239-353-4231
Practice Address - Street 1:1755 HERITAGE TRL
Practice Address - Street 2:SUITE 604, UNIT A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-7600
Practice Address - Country:US
Practice Address - Phone:239-353-4101
Practice Address - Fax:239-353-4231
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003486L207Q00000X
FLOS11273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIC604ZOtherMEDICARE
FL014450000Medicaid
FLIC604ZOtherMEDICARE