Provider Demographics
NPI:1477134088
Name:TRITON MD LLC
Entity Type:Organization
Organization Name:TRITON MD LLC
Other - Org Name:THRIVE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-799-8466
Mailing Address - Street 1:2020 PONCE DE LEON BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4475
Mailing Address - Country:US
Mailing Address - Phone:305-224-8850
Mailing Address - Fax:855-940-6025
Practice Address - Street 1:2020 PONCE DE LEON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4475
Practice Address - Country:US
Practice Address - Phone:305-224-8850
Practice Address - Fax:855-940-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty