Healthcare Provider Details

I. General information

NPI: 1205850385
Provider Name (Legal Business Name): PETER STU KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 W BOYNTON BEACH BLVD 12
BOYNTON BEACH FL
33436-4642
US

IV. Provider business mailing address

3301 W BOYNTON BEACH BLVD 12
BOYNTON BEACH FL
33436-4642
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-8434
  • Fax: 561-738-6456
Mailing address:
  • Phone: 561-737-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME37959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: