Provider Demographics
NPI:1538248653
Name:FITZER, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:FITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OCEAN KEY WAY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-7359
Mailing Address - Country:US
Mailing Address - Phone:561-747-8770
Mailing Address - Fax:
Practice Address - Street 1:115 OCEAN KEY WAY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7359
Practice Address - Country:US
Practice Address - Phone:561-747-8770
Practice Address - Fax:561-747-0093
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00625572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001281500Medicaid
PA1025382860001Medicaid
OH2924965Medicaid
SCQ62557Medicaid
OH2924965Medicaid
FL001281500Medicaid
SCQ62557Medicaid
PA1025382860001Medicaid