MEDICARE: DR. PETER N. SOUDIJN 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	207R00000X	Internal Medicine Physician	ME63325	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110101732	OTHER	FL	RAILROAD MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558314179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER N. SOUDIJN M.D.

Provider Business Mailing Address
First Line	:	29750 US HIGHWAY 19 N STE 101
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-1510
Country	:	US
Telephone Number	:	727-786-5058
Fax Number	:	813-635-2639

Provider Business Practice Location Address
First Line	:	29750 US HIGHWAY 19 N STE 101
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-1510
Country	:	US
Telephone Number	:	727-786-5058
Fax Number	:	813-635-2639

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/04/2021

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Directions to “ DR. PETER N. SOUDIJN M.D.” Practice Location

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