MEDICARE: ZOE TAN PEREDA 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
1	208D00000X	General Practice Physician	ACN1737	FL

General Provider Information

NPI Number	:	1942053467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOE TAN PEREDA MD

Provider Business Mailing Address
First Line	:	12839 IVORY STONE LOOP
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-6744
Country	:	US
Telephone Number	:	239-202-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	17801 MURDOCK CIR UNIT C
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-4003
Country	:	US
Telephone Number	:	941-629-3500
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	05/13/2026

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