Healthcare Provider Details

I. General information

NPI: 1013195759
Provider Name (Legal Business Name): PETER L MATTEI IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 08/02/2025
Certification Date: 08/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 UNIVERSITY PKWY STE 302
SARASOTA FL
34240-9048
US

IV. Provider business mailing address

15006 BOWFIN TER
LAKEWOOD RANCH FL
34202-5819
US

V. Phone/Fax

Practice location:
  • Phone: 941-800-5001
  • Fax: 941-800-5012
Mailing address:
  • Phone: 609-330-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2015-02351
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME122865
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2015-02351
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME122865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: