MEDICARE: DR. PETER ANTHONY VENEZIANO DO

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	DO224	AL
2	207R00000X	Internal Medicine Physician	051097	GA
3	207R00000X	Internal Medicine Physician	4395	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51529577	OTHER	AL	BCBS OF ALABAMA

General Provider Information

NPI Number	:	1679567341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANTHONY VENEZIANO DO

Provider Business Mailing Address
First Line	:	101 E BRUNSON ST
Second Line	:	SUITE 200
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2526
Country	:	US
Telephone Number	:	334-393-3686
Fax Number	:	334-347-4906

Provider Business Practice Location Address
First Line	:	101 E BRUNSON ST
Second Line	:	SUITE 200
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2526
Country	:	US
Telephone Number	:	334-393-3686
Fax Number	:	334-347-4906

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. PETER ANTHONY VENEZIANO DO” Practice Location

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