Provider Demographics
NPI:1306212071
Name:BROMLEY, PETER
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BROMLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 COUNTRY CLUB RD STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6042
Mailing Address - Country:US
Mailing Address - Phone:910-938-9595
Mailing Address - Fax:910-938-7595
Practice Address - Street 1:1715 COUNTRY CLUB RD STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6042
Practice Address - Country:US
Practice Address - Phone:910-938-9595
Practice Address - Fax:910-938-7595
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1328237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist