Provider Demographics
NPI:1073510095
Name:SZYMONIAK, PETER MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MATTHEW
Last Name:SZYMONIAK
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 1:6007 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4008
Mailing Address - Country:US
Mailing Address - Phone:850-626-1461
Mailing Address - Fax:850-626-3161
Practice Address - Street 1:6007 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4008
Practice Address - Country:US
Practice Address - Phone:850-626-1461
Practice Address - Fax:850-626-3161
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044109174400000X
FLME44109207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009310670OtherALACAID
FL068633600Medicaid
AL009310670Medicaid
FL57095OtherBLUE CROSS BLUE SHIELD
FL068633600Medicaid
AL009310670OtherALACAID
AL009310670Medicaid