Provider Demographics
NPI:1225200116
Name:HERVIE, PETER K (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:HERVIE
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 1:5924 AUVERS BLVD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3764
Mailing Address - Country:US
Mailing Address - Phone:201-696-5881
Mailing Address - Fax:
Practice Address - Street 1:844 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4003
Practice Address - Country:US
Practice Address - Phone:407-894-8768
Practice Address - Fax:407-894-6872
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234619208000000X
FLME110130208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000379580Medicaid
FL003795800Medicaid