Healthcare Provider Details

I. General information

NPI: 1477134088
Provider Name (Legal Business Name): TRITON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PONCE DE LEON BLVD STE 103
CORAL GABLES FL
33134-4475
US

IV. Provider business mailing address

2020 PONCE DE LEON BLVD STE 103
CORAL GABLES FL
33134-4475
US

V. Phone/Fax

Practice location:
  • Phone: 786-801-3825
  • Fax: 305-508-6910
Mailing address:
  • Phone: 786-801-3825
  • Fax: 305-508-6910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER MICHAEL
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 305-799-8466