Healthcare Provider Details

I. General information

NPI: 1619384187
Provider Name (Legal Business Name): PETER TEPLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157-1778
US

IV. Provider business mailing address

4465 N MICHIGAN AVE
MIAMI BEACH FL
33140-2958
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax:
Mailing address:
  • Phone: 786-301-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number140092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: