Provider Demographics
NPI:1730175977
Name:BENTZ, SHELBY L (MD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:BENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 TRUXTUN AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3044
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:661-335-7766
Practice Address - Street 1:4105 EMPIRE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0637
Practice Address - Country:US
Practice Address - Phone:661-325-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80199207L00000X
IA38044207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G801990Medicaid
CAWG80199AMedicare PIN
IAI09230020Medicare PIN
CAG48761Medicare UPIN