Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO4014 | FL |
Y | 222Z00000X | Podiatrist | PO4014 | FL |
NPI | 1033572656 |
---|---|
Provider Name | Felipe Peterson |
First Address | St Petersburg, FL 33704-4123 |
Second Address | St Petersburg, FL 33704-4123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 16/12/2020 |