Individual
ANN E. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 254-4900
(321) 674-9196
Mailing address
1223 GATEWAY DR, MELBOURNE, FL 32901-2607
(321) 254-4900
(321) 674-9196
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME49386
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376632200
—
FL
01
—
P00308119
RR MEDICARE
FL
Enumeration date
12/02/2005
Last updated
08/18/2010
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