Individual
PETER G SELASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1061 MEDICAL CENTER DR, SUITE 110, ORANGE CITY, FL 32763-8200
(386) 774-1223
(386) 774-4658
Mailing address
1061 MEDICAL CENTER DR, SUITE 110, ORANGE CITY, FL 32763-8200
(386) 774-1223
(386) 774-4658
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME36870
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069666800
—
FL
Enumeration date
05/05/2006
Last updated
04/23/2010
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