Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | ME69807 | FL |
NPI | 1063402980 |
---|---|
Provider Name | Dr. Peter Melvin Mcintosh |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2005 |
Last Update Date | 22/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250008342 | RAILROAD MEDICARE (01) | FL |
268761500 | (05) | FL |
45051 | BLUECROSS/BLUESHIELD (01) | FL |
G21083 | (02) | FL |