Individual
DR. PETER MICHAEL WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1480 N UNIVERSITY DR, CORAL SPRINGS, FL 33071-6040
(954) 753-1030
(954) 753-1115
Mailing address
1480 N UNIVERSITY DR, CORAL SPRINGS, FL 33071-6040
(954) 753-1030
(954) 753-1115
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0029164
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008978
GHI PROVIDER ID
FL
05
—
057349300
—
FL
01
—
0706177
AETNA ID
FL
01
—
406073297
RR MEDICARE
FL
01
—
4958275
CIGNA ID
FL
Enumeration date
07/26/2005
Last updated
07/15/2010
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