Provider Demographics
NPI:1447218276
Name:VITULLI, PETER ANDREW JR (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:VITULLI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:ANDREW
Other - Last Name:VITULLI
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DO, PA
Mailing Address - Street 1:4600 MILITARY TRL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4810
Mailing Address - Country:US
Mailing Address - Phone:561-427-2000
Mailing Address - Fax:561-776-2565
Practice Address - Street 1:4600 MILITARY TRL
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4810
Practice Address - Country:US
Practice Address - Phone:561-427-2000
Practice Address - Fax:561-776-2565
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8005207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05615546OtherAETNA
FL1803436OtherUNITED
FL81700OtherBCBS
FL291080OtherAVMED
FL2299239OtherGHI
FL81700OtherBCBS
FL81700Medicare ID - Type Unspecified