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NPI Code Detail

MEDICARE: PETER A. NASSAR, M.D., P.A.

MEDICARE: PETER A. NASSAR, M.D., P.A.
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
1207RP1001XPulmonary Disease PhysicianME94669FL
2207RS0012XSleep Medicine (Internal Medicine) PhysicianME94669FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6P00629712OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1299886OTHERFLAVMED
26428573OTHERFLCIGNA
331047OTHERFLBCBS OF FL
47329770OTHERFLAETNA
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609000215
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETER A. NASSAR, M.D., P.A.
Provider Business Mailing Address
First Line : 3537 CREST ST
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32092-3801
Country : US
Telephone Number : 904-236-9331
Fax Number : 904-338-0533
Provider Business Practice Location Address
First Line : 6930 BONNEVAL RD
Second Line : SUITE 2
City : JACKSONVILLE
State : FL
Zip : 32216-6084
Country : US
Telephone Number : 904-854-6899
Fax Number : 904-338-0533
Authorized Official
Title or Position : OWNER
Name : DR. PETER A NASSAR
Credential : MD
Telephone Number : 904-236-9331
Provider Enumeration Date : 05/11/2009
Last Update Date : 03/01/2012

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