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General NPI Number Information
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NPI Number | 1285696690
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Entity Type | Individual
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Provider Name | PETER ARNOLD SEREQUE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 250 N GROVE MEDICAL PARK DR
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City | SPARTANBURG
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State | SC
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Zip | 29303-4222
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Country | US
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Telephone | 864-560-7002
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Fax | 864-560-6009
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Provider Business Mailing Address
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Address Line | 248 LAKE FOREST DR
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City | SPARTANBURG
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State | SC
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Zip | 29307-3753
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Country | US
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Telephone | 864-541-4957
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Fax | 864-560-6009
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 07180
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License Number State | SC
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