Individual
FREDERICK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6100 MINTON RD NW, STE104, PALM BAY, FL 32907-1975
(321) 724-1172
(321) 724-9024
Mailing address
6100 MINTON RD NW, STE104, PALM BAY, FL 32907-1975
(321) 724-1172
(321) 724-9024
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME32196
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038494100
—
FL
01
—
080185086
RAILROAD MEDICARE
FL
01
—
200859
WELLCARE
FL
01
—
2049145010
CIGNA
FL
01
—
2830929
AETNA
FL
01
—
5840654
AETNA
FL
01
—
62193
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/21/2005
Last updated
03/30/2021
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