MEDICARE: DR. PETER PATRICK SFORZA 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	2085R0202X	Diagnostic Radiology Physician	0101040333	VA

General Provider Information

NPI Number	:	1770638090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER PATRICK SFORZA M.D.

Provider Business Mailing Address
First Line	:	1360 ANTIOCH RD
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9411
Country	:	US
Telephone Number	:	870-793-6940
Fax Number	:	870-793-6940

Provider Business Practice Location Address
First Line	:	1360 ANTIOCH RD
Second Line	:
City	:	CAVE CITY
State	:	AR
Zip	:	72521-9411
Country	:	US
Telephone Number	:	870-793-6940
Fax Number	:	870-793-6940

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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