Provider Demographics
NPI:1326079864
Name:SEGALL, PETER HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HOWARD
Last Name:SEGALL
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 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 750 A
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2755
Mailing Address - Country:US
Mailing Address - Phone:305-674-2755
Mailing Address - Fax:305-674-2725
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 750A
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-674-2755
Practice Address - Fax:305-674-2725
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030417174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372533200Medicaid
FL372533200Medicaid
FL92829YMedicare PIN