Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ME802582 | FL |
Y | 222Z00000X | Podiatrist | ME802582 | FL |
NPI | 1053345074 |
---|---|
Provider Name | Peter Bentley |
First Address | Hialeah, FL 33012-5427 |
Second Address | Plantation, FL 33317-5035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 20/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
J90338900 | (05) | FL |
U74671 | (02) | FL |