Provider Demographics
NPI:1417132176
Name:PETER D. SARBONE, M.D., P.A.
Entity Type:Organization
Organization Name:PETER D. SARBONE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-491-4304
Mailing Address - Street 1:5601 N. DIXIE HIGHWAY
Mailing Address - Street 2:SUITE #401
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334
Mailing Address - Country:US
Mailing Address - Phone:954-491-4304
Mailing Address - Fax:954-491-4350
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE #401
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-491-4304
Practice Address - Fax:954-491-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39384207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79651Medicare PIN