Healthcare Provider Details

I. General information

NPI: 1477510915
Provider Name (Legal Business Name): BENDT P PETERSEN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/04/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 AIRPORT BLVD STE 100
MOBILE AL
36608-6701
US

IV. Provider business mailing address

6701 AIRPORT BLVD BUILDING D SUITE 100
MOBILE AL
36608
US

V. Phone/Fax

Practice location:
  • Phone: 251-607-6117
  • Fax: 251-219-0746
Mailing address:
  • Phone: 251-607-6117
  • Fax: 251-219-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number00016728
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: