Provider Demographics
NPI:1629157243
Name:NASSAR, PETER ANTON (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANTON
Last Name:NASSAR
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:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-398-3760
Mailing Address - Fax:904-338-0533
Practice Address - Street 1:6930 BONNEVAL RD
Practice Address - Street 2:SUITE #2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6012
Practice Address - Country:US
Practice Address - Phone:904-854-6899
Practice Address - Fax:904-338-0533
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94669207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274620400Medicaid
FL593385828OtherUNITED HEALTHCARE
FL29986OtherAV MED
FL7329770OtherAETNA
FL31047OtherBCBS
FL593385828OtherUNITED HEALTHCARE
FL31047VMedicare PIN
FL31047OtherBCBS