Healthcare Provider Details

I. General information

NPI: 1225200116
Provider Name (Legal Business Name): PETER K HERVIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N THORNTON AVE
ORLANDO FL
32803-4003
US

IV. Provider business mailing address

5924 AUVERS BLVD UNIT 104
ORLANDO FL
32807-3764
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8768
  • Fax: 407-894-6872
Mailing address:
  • Phone: 201-696-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234619
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME110130
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME110130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: