Individual
JOSEPH PHILLIP PETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
332 MEDCREST DRIVE, CRESTVIEW, FL 32536
(850) 683-5100
(850) 683-5102
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 254-5920
(239) 254-5921
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME74916
FL
208D00000X
General Practice Physician
ME74916
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255307400
—
FL
Enumeration date
07/07/2006
Last updated
11/10/2021
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