Provider Demographics
NPI:1174605364
Name:BENTLEY, DAVID ERIC (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9663
Mailing Address - Country:US
Mailing Address - Phone:270-465-7505
Mailing Address - Fax:270-789-3860
Practice Address - Street 1:1878 OLD LEBANON RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9663
Practice Address - Country:US
Practice Address - Phone:270-465-7505
Practice Address - Fax:270-789-3860
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24667208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY48C4OtherBC/BS
KY020025461OtherRAILROAD MEDICARE
KY64246671Medicaid
KY000000062911OtherANTHEM BCBS
KY000000062911OtherANTHEM BCBS
KYBB 0485525OtherDEA NUMBER
KY020025461OtherRAILROAD MEDICARE