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General NPI Number Information
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NPI Number | 1023046885
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Entity Type | Individual
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Provider Name | PETER MANGONE ZIES MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17 EAST SILVER PALM AVENUE
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City | MELBOURNE
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State | FL
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Zip | 32901-3123
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Country | US
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Telephone | 321-725-9041
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Fax | 321-722-9248
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Provider Business Mailing Address
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Address Line | 17 EAST SILVER PALM AVENUE
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City | MELBOURNE
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State | FL
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Zip | 32901-3123
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Country | US
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Telephone | 321-725-9041
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Fax | 321-722-9248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 14855
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License Number State | FL
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