Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35.098332 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35.098332 | OH |
NPI | 1114238805 |
---|---|
Provider Name | Jared Carson Bentley |
First Address | Portsmouth, OH 45662-2681 |
Second Address | Portsmouth, OH 45662-2657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2010 |
Last Update Date | 22/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0077256 | (05) | OH |