Provider Demographics
NPI:1033275565
Name:MCCAMBRIDGE, PETER SCOTT
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:SCOTT
Last Name:MCCAMBRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 S CYPRESSHEAD DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1601
Mailing Address - Country:US
Mailing Address - Phone:561-289-0504
Mailing Address - Fax:954-255-2483
Practice Address - Street 1:7310 S CYPRESSHEAD DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-1601
Practice Address - Country:US
Practice Address - Phone:561-289-0504
Practice Address - Fax:954-255-2483
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
F01155OtherCERTIFICATION # F01155