Provider Demographics
NPI:1194841155
Name:SARBONE, PETER DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DAVID
Last Name:SARBONE
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 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-491-4304
Mailing Address - Fax:954-491-4350
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-491-4304
Practice Address - Fax:954-491-4350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39384207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD67323Medicare ID - Type Unspecified
FL79651Medicare UPIN