Provider Demographics
NPI:1376782607
Name:BRINGEWALD, PETER ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROBERT
Last Name:BRINGEWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 OAK HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-6741
Mailing Address - Country:US
Mailing Address - Phone:830-990-0301
Mailing Address - Fax:
Practice Address - Street 1:617 OAK HAVEN RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-6741
Practice Address - Country:US
Practice Address - Phone:830-990-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty