Individual
NICHOLAS PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
(305) 325-5511
Mailing address
1611 NW 12TH AVE, MIAMI, FL 33136-1005
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
TRN40885
FL
Other
Enumeration date
05/23/2019
Last updated
06/25/2024
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