Provider Demographics
NPI:1043951098
Name:DARREN PETERSON, PLLC
Entity Type:Organization
Organization Name:DARREN PETERSON, PLLC
Other - Org Name:FLORIDA COAST WEIGHT LOSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-506-9281
Mailing Address - Street 1:50 CYPRESS POINT PKWY STE B1&B2
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2500
Mailing Address - Country:US
Mailing Address - Phone:386-506-9281
Mailing Address - Fax:
Practice Address - Street 1:50 CYPRESS POINT PKWY STE B1&B2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2500
Practice Address - Country:US
Practice Address - Phone:386-506-9281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty