Provider Demographics
NPI:1063654929
Name:PETER WROBEL MD PC
Entity Type:Organization
Organization Name:PETER WROBEL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WROBEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:912-283-1359
Mailing Address - Street 1:1718 REYNOLDS STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4574
Mailing Address - Country:US
Mailing Address - Phone:912-283-1359
Mailing Address - Fax:912-283-1362
Practice Address - Street 1:1718 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1065
Practice Address - Country:US
Practice Address - Phone:912-283-1359
Practice Address - Fax:912-283-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 208VP0000X, 208VP0014X, 207Q00000X
GA040285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000672339EMedicaid
GA000672339FMedicaid
GA000672339FMedicaid