Provider Demographics
NPI:1043214539
Name:BLITZER, PETER H (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:BLITZER
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7341 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5122
Practice Address - Country:US
Practice Address - Phone:239-489-3420
Practice Address - Fax:239-489-3219
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00479082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24-05257OtherUHC PROVIDER NUMBER
FL0053977-017OtherCIGNA PROVIDER NUMBER
FL202575OtherAVMED PROVIDER NUMBER
FL85445OtherOP. ENG. LOC. 825 PROV. #
FL00788OtherUNV. HLTHCR. PROVIDER #
FL0624230OtherAETNA HMO PROVIDER NUMBER
FL90546OtherFIRST HEALTH PROVIDER NUM
FL920004623OtherRAILROAD MEDICARE
FLME47908AOtherMETCARE PROVIDER ID #
FL4129691OtherAETNA OTHER PROVIDER NUM.
FL592485899OtherMETCARE VENDOR ID #
FL045283100Medicaid
FL273709OtherGREAT WEST REFERENCE NUM.
FL73297OtherBCBS PROVIDER NUMBER
FL592485899OtherMETCARE VENDOR ID #
FL85445OtherOP. ENG. LOC. 825 PROV. #