MEDICARE: DR. PETER ARNOLD SEREQUE M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	07180	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285696690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ARNOLD SEREQUE M.D.

Provider Business Mailing Address
First Line	:	248 LAKE FOREST DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-3753
Country	:	US
Telephone Number	:	864-541-4957
Fax Number	:	864-560-6009

Provider Business Practice Location Address
First Line	:	250 N GROVE MEDICAL PARK DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-4222
Country	:	US
Telephone Number	:	864-560-7002
Fax Number	:	864-560-6009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/23/2011

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