Healthcare Provider Details

I. General information

NPI: 1629157243
Provider Name (Legal Business Name): PETER ANTON NASSAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 BONNEVAL RD SUITE #2
JACKSONVILLE FL
32216-6012
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-6899
  • Fax: 904-338-0533
Mailing address:
  • Phone: 904-398-3760
  • Fax: 904-338-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME94669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: