Healthcare Provider Details

I. General information

NPI: 1912946211
Provider Name (Legal Business Name): PETER ANDREW RIQUETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 EASTHAVEN CT
NEW PORT RICHEY FL
34655-5214
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-0096
  • Fax: 813-635-2697
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME83140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: