Provider Demographics
NPI:1497711634
Name:BRONEC, PETER ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ROBERT
Last Name:BRONEC
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 1:3901 N ROXBORO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2181
Mailing Address - Country:US
Mailing Address - Phone:919-479-4120
Mailing Address - Fax:919-479-4204
Practice Address - Street 1:3901 N ROXBORO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2181
Practice Address - Country:US
Practice Address - Phone:919-479-4120
Practice Address - Fax:919-479-4204
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30998207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7918567Medicaid
NC7918567Medicaid
NC203993DMedicare ID - Type Unspecified