Healthcare Provider Details

I. General information

NPI: 1265497549
Provider Name (Legal Business Name): JOHN M. PETERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-8357
  • Fax: 305-669-6406
Mailing address:
  • Phone: 305-662-8357
  • Fax: 305-669-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberOS14046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: