Provider Demographics
NPI:1376593913
Name:DEBELIUS-ENEMARK, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:DEBELIUS-ENEMARK
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 1:1619 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4620
Mailing Address - Country:US
Mailing Address - Phone:850-431-5119
Mailing Address - Fax:850-431-2467
Practice Address - Street 1:1616 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4619
Practice Address - Country:US
Practice Address - Phone:850-431-5105
Practice Address - Fax:850-431-6105
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00618632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15126OtherBLUECROSSBLUESHEILD
FL262880500Medicaid
FLF35268Medicare UPIN
FL262880500Medicaid