Provider Demographics
NPI:1023046885
Name:ZIES, PETER MANGONE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MANGONE
Last Name:ZIES
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 1:17 EAST SILVER PALM AVENUE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3123
Mailing Address - Country:US
Mailing Address - Phone:321-725-9041
Mailing Address - Fax:321-722-9248
Practice Address - Street 1:17 EAST SILVER PALM AVENUE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3123
Practice Address - Country:US
Practice Address - Phone:321-725-9041
Practice Address - Fax:321-722-9248
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14855207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
139150553743OtherHUMANA
CL1732OtherRR MEDICARE
D55350OtherHEALTH FIRST
48587OtherBCBS
FL48587Medicare ID - Type Unspecified
D55350OtherHEALTH FIRST
48587Medicare ID - Type Unspecified