Healthcare Provider Details

I. General information

NPI: 1124006127
Provider Name (Legal Business Name): PETER MUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BAKER AVENUE EXT 305
CONCORD MA
01742-2143
US

IV. Provider business mailing address

526 MAIN ST
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 978-371-7010
  • Fax:
Mailing address:
  • Phone: 978-849-7505
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number75553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: