=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871564377
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AREA WOMENS CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 S FORT HARRISON AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-447-7786
-----------------------------------------------------
Fax | 727-447-5978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 S FORT HARRISON AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-447-7786
-----------------------------------------------------
Fax | 727-447-5978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID O PETERFREUND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-447-7786
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------