MEDICARE: PETER BENTLEY DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	ME802582	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053345074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER BENTLEY DPM

Provider Business Mailing Address
First Line	:	3233 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5427
Country	:	US
Telephone Number	:	305-826-0660
Fax Number	:	305-825-0245

Provider Business Practice Location Address
First Line	:	1660 SW 72ND AVE
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-5035
Country	:	US
Telephone Number	:	305-826-0660
Fax Number	:	305-825-0245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/20/2016

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Directions to “ PETER BENTLEY DPM” Practice Location

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