Provider Demographics
NPI:1518174804
Name:PETER F LOFASO D O LLC
Entity Type:Organization
Organization Name:PETER F LOFASO D O LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:LOFASO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-848-3761
Mailing Address - Street 1:3975 ISLES VIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8854
Mailing Address - Country:US
Mailing Address - Phone:561-615-1355
Mailing Address - Fax:561-615-1356
Practice Address - Street 1:3975 ISLES VIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8854
Practice Address - Country:US
Practice Address - Phone:561-615-1355
Practice Address - Fax:561-615-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4447Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER I
FLH85052Medicare UPIN