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General NPI Number Information
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NPI Number | 1619477288
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Entity Type | Organization
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Legal Business Name | PETER R. BENDETSON, M.D.
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 13005 SOUTHERN BLVD STE 231
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9272
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Country | US
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Telephone | 561-328-9434
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Fax | 561-469-2496
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Provider Business Mailing Address
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Address Line | 13005 SOUTHERN BLVD STE 231
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9272
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Country | US
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Telephone | 561-328-9434
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Fax | 561-469-2496
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | PETER ROME BENDESTON
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Credential | MD
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Telephone | 561-328-9434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME38840
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License Number State | FL
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