Provider Demographics
NPI:1235165671
Name:BREGMAN, PETER J (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:BREGMAN
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 1:7150 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1982
Mailing Address - Country:US
Mailing Address - Phone:702-703-2526
Mailing Address - Fax:702-703-2527
Practice Address - Street 1:7150 W SUNSET RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1982
Practice Address - Country:US
Practice Address - Phone:027-013-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1101213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1235165671Medicaid
NV1235165671Medicaid
MA480030459OtherRAILROAD MEDICARE
MA0311022Medicaid
MA1215040001Medicare NSC