Individual
DR. VINCENT GLENN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-9443
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-9443
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
OS14032
FL
207RI0011X
Interventional Cardiology Physician
Primary
OS14032
FL
207UN0901X
Nuclear Cardiology Physician
OS14032
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278018600
—
FL
01
—
88976
BCBS FL
FL
Enumeration date
08/26/2009
Last updated
09/19/2022
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