Individual
PETER E. PENICO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2020 59TH ST W, BRADENTON, FL 34209-4604
(941) 798-6303
Mailing address
18167 US HIGHWAY 19 N, SUITE 285, CLEARWATER, FL 33764-3528
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME36495
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036286700
—
FL
01
—
41193
BCBS
FL
Enumeration date
05/18/2006
Last updated
03/14/2008
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