Healthcare Provider Details

I. General information

NPI: 1487623187
Provider Name (Legal Business Name): JAMES ERIC PETERZELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 SW 80TH ST STE 8
OCALA FL
34481-9117
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-1922
  • Fax:
Mailing address:
  • Phone: 800-480-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS11883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: