=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861445421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER ISTVAN ACS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 02/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1147 NW 64TH TER
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32605-4218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-332-3900
-----------------------------------------------------
Fax | 352-332-5009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4371 VERONICA S SHOEMAKER BLVD ATTN: CREDENTIAL DEPT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33916-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-274-8200
-----------------------------------------------------
Fax | 239-278-3350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME95855
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------