Healthcare Provider Details

I. General information

NPI: 1356627335
Provider Name (Legal Business Name): PETER JAMES STIBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 PAVIA LOOP
LAKE MARY FL
32746-2658
US

IV. Provider business mailing address

621 PAVIA LOOP
LAKE MARY FL
32746-2658
US

V. Phone/Fax

Practice location:
  • Phone: 863-226-7417
  • Fax:
Mailing address:
  • Phone: 863-226-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberHSE38975
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License NumberRA41
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: