Healthcare Provider Details

I. General information

NPI: 1871564377
Provider Name (Legal Business Name): BAY AREA WOMENS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S FORT HARRISON AVE
CLEARWATER FL
33756
US

IV. Provider business mailing address

1055 S FORT HARRISON AVE
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-7786
  • Fax: 727-447-5978
Mailing address:
  • Phone: 727-447-7786
  • Fax: 727-447-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID O PETERFREUND
Title or Position: PRESIDENT
Credential: MD
Phone: 727-447-7786