MEDICARE: PETER T BENTLEY DPM PA

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

General Provider Information

NPI Number	:	1760012827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER T BENTLEY DPM PA

Provider Business Mailing Address
First Line	:	1660 SW 72ND AVE
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-5035
Country	:	US
Telephone Number	:	954-548-5387
Fax Number	:

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER T BENTLEY
Credential	:	DPM
Telephone Number	:	954-548-5387

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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