Provider Demographics
NPI:1033572656
Name:PETERSON, FELIPE (DPM)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:FELIPE
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3506 COASTAL DUSK DR
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-5943
Mailing Address - Country:US
Mailing Address - Phone:954-547-0445
Mailing Address - Fax:
Practice Address - Street 1:1401 16TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4123
Practice Address - Country:US
Practice Address - Phone:727-291-7343
Practice Address - Fax:727-895-1215
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4014213E00000X, 213ES0131X, 213EP1101X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXOQ6LOtherBCBS
14673711OtherCAQH ID
FL106555400Medicaid