Healthcare Provider Details

I. General information

NPI: 1376593913
Provider Name (Legal Business Name): PETER C. DEBELIUS-ENEMARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 M D LN STE A
TALLAHASSEE FL
32308-5349
US

IV. Provider business mailing address

2606 CENTENNIAL PL
TALLAHASSEE FL
32308-0572
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-0635
  • Fax: 850-205-0195
Mailing address:
  • Phone: 850-205-0189
  • Fax: 850-329-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0061863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: