Healthcare Provider Details

I. General information

NPI: 1417132176
Provider Name (Legal Business Name): PETER D. SARBONE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 N DIXIE HWY SUITE #401
OAKLAND PARK FL
33334-4148
US

IV. Provider business mailing address

5601 N. DIXIE HIGHWAY SUITE #401
FORT LAUDERDALE FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-4304
  • Fax: 954-491-4350
Mailing address:
  • Phone: 954-491-4304
  • Fax: 954-491-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME39384
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME39384
License Number StateFL

VIII. Authorized Official

Name: DR. PETER D SARBONE
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 954-491-4304