Provider Demographics
NPI:1396857611
Name:DOVGAN, PETER SAMO (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SAMO
Last Name:DOVGAN
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 1:655 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1485
Mailing Address - Country:US
Mailing Address - Phone:321-751-2707
Mailing Address - Fax:321-255-2361
Practice Address - Street 1:655 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1485
Practice Address - Country:US
Practice Address - Phone:321-751-2707
Practice Address - Fax:321-255-2361
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME795942086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256748200Medicaid
FL46900OtherBCBS
FL46900XMedicare PIN
G95379Medicare UPIN
FL256748200Medicaid