Provider Demographics
NPI:1316021124
Name:BABINSKI, PETER LEON (MD PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LEON
Last Name:BABINSKI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST BROWARD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2020
Mailing Address - Country:US
Mailing Address - Phone:954-463-5406
Mailing Address - Fax:954-522-2456
Practice Address - Street 1:800 EAST BROWARD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2020
Practice Address - Country:US
Practice Address - Phone:954-463-5406
Practice Address - Fax:954-522-2456
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36538207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379671000Medicaid
D63618Medicare UPIN
FL379671000Medicaid