Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 234619 | MA |
N | 208000000X | Pediatrician | ME110130 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME110130 | FL |
NPI | 1225200116 |
---|---|
Provider Name | Peter K Hervie |
First Address | Orlando, FL 32807-3764 |
Second Address | Orlando, FL 32803-4003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000379580 | (05) | FL |
003795800 | (05) | FL |