MEDICARE: DR. PETER L MATTEI IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	2015-02351	NC
2	207N00000X	Dermatology Physician	ME122865	FL
3	207N00000X	Dermatology Physician	2015-02351	NC
4	207ND0101X	MOHS-Micrographic Surgery Physician	ME122865	FL

General Provider Information

NPI Number	:	1013195759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER L MATTEI IV M.D.

Provider Business Mailing Address
First Line	:	15006 BOWFIN TER
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-5819
Country	:	US
Telephone Number	:	609-330-2168
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 UNIVERSITY PKWY STE 302
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9048
Country	:	US
Telephone Number	:	941-800-5001
Fax Number	:	941-800-5012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	05/29/2026

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