Provider Demographics
NPI:1760012827
Name:PETER T BENTLEY DPM PA
Entity Type:Organization
Organization Name:PETER T BENTLEY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-548-5387
Mailing Address - Street 1:1660 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5035
Mailing Address - Country:US
Mailing Address - Phone:954-548-5387
Mailing Address - Fax:
Practice Address - Street 1:3233 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5427
Practice Address - Country:US
Practice Address - Phone:305-826-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty