Provider Demographics
NPI:1053345074
Name:BENTLEY, PETER (DPM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5427
Mailing Address - Country:US
Mailing Address - Phone:305-826-0660
Mailing Address - Fax:305-825-0245
Practice Address - Street 1:1660 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5035
Practice Address - Country:US
Practice Address - Phone:305-826-0660
Practice Address - Fax:305-825-0245
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME802582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ90338900Medicaid
FLJ90338900Medicaid
FLU74671Medicare UPIN