Healthcare Provider Details

I. General information

NPI: 1104857747
Provider Name (Legal Business Name): PETER J AMEGLIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 PORTO FINO CIR
FORT MYERS FL
33912-4361
US

IV. Provider business mailing address

6839 PORTO FINO CIR
FORT MYERS FL
33912-4361
US

V. Phone/Fax

Practice location:
  • Phone: 239-990-8138
  • Fax: 238-237-3180
Mailing address:
  • Phone: 239-990-8138
  • Fax: 239-237-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME131013
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberME131013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: