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NPI Code Detail

MEDICARE: DR. PETER MANGONE ZIES MD

MEDICARE:  DR. PETER MANGONE ZIES  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician14855FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CL1732OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1139150553743OTHERHUMANA
3D55350OTHERHEALTH FIRST
448587OTHERBCBS

General Provider Information

NPI Number : 1023046885
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER MANGONE ZIES MD
Provider Business Mailing Address
First Line : 17 EAST SILVER PALM AVENUE
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3123
Country : US
Telephone Number : 321-725-9041
Fax Number : 321-722-9248
Provider Business Practice Location Address
First Line : 17 EAST SILVER PALM AVENUE
Second Line :
City : MELBOURNE
State : FL
Zip : 32901-3123
Country : US
Telephone Number : 321-725-9041
Fax Number : 321-722-9248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 07/08/2007

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Directions to “ DR. PETER MANGONE ZIES MD” Practice Location

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