Individual
DR. PAUL LEWIS PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3663 S MIAMI AVE, MIAMI, FL 33133-4253
(305) 665-4614
(305) 667-0239
Mailing address
5901 SW 74TH ST, SUITE 202, MIAMI, FL 33143-5165
(305) 665-4614
(305) 667-0239
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME82450
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03222
BCBS
FL
05
—
262547400
—
FL
Enumeration date
09/16/2006
Last updated
08/08/2019
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