MEDICARE: DR. PETER A. NAMNUM 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	207R00000X	Internal Medicine Physician	ME61361	FL

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	:	1770561177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A. NAMNUM M.D.

Provider Business Mailing Address
First Line	:	8 MENDOTA LN
Second Line	:	SUITE 110
City	:	SEA RANCH LAKES
State	:	FL
Zip	:	33308-2317
Country	:	US
Telephone Number	:	954-835-0750
Fax Number	:	954-835-0760

Provider Business Practice Location Address
First Line	:	8199 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-1744
Country	:	US
Telephone Number	:	954-591-8034
Fax Number	:	210-761-3397

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

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	06/12/2025

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