# PETER HERTZAK M.D. PMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205075256
- **Authorized official:** DR. PETER H HERTZAK (OWNER)
- **Authorized official phone:** (985) 641-6300

## Contact information

- **Practice address:** 985 ROBERT BLVD STE 102, SLIDELL, LA 70458-2063
- **Practice address phone:** (985) 641-6300
- **Practice address fax:** (985) 646-1409
- **Mailing address:** 985 ROBERT BLVD STE 102, SLIDELL, LA 70458-2063
- **Mailing address phone:** (985) 641-6300
- **Mailing address fax:** (985) 646-1409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 05273R | LA | Yes |

## Other

- **Enumeration date:** 02/16/2009
- **Last updated:** 04/15/2009