Provider Demographics
NPI:1770638090
Name:SFORZA, PETER PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PATRICK
Last Name:SFORZA
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 1:1360 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72521-9411
Mailing Address - Country:US
Mailing Address - Phone:870-793-6940
Mailing Address - Fax:870-793-6940
Practice Address - Street 1:1360 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:AR
Practice Address - Zip Code:72521-9411
Practice Address - Country:US
Practice Address - Phone:870-793-6940
Practice Address - Fax:870-793-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010403332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF73113Medicare ID - Type Unspecified