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General NPI Number Information
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NPI Number | 1740902410
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Entity Type | Individual
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Provider Name | PETER BOHAM SEPTEMBRE PA
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Gender | Male
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 1505 DELAWARE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34950-3975
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Country | US
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Telephone | 772-461-1401
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Fax |
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Provider Business Mailing Address
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Address Line | 1858 SW ANGELICO LN
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-4457
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Country | US
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Telephone | 772-722-4907
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9834
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.009517RX
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | TPPA389
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001312-P.A.
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License Number State | PR
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