Provider Demographics
NPI:1013997667
Name:ERIGOYEN, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ERIGOYEN
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 1:200 EVERGLADE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33480-7420
Mailing Address - Country:US
Mailing Address - Phone:561-248-5979
Mailing Address - Fax:305-633-6332
Practice Address - Street 1:200 EVERGLADE AVE
Practice Address - Street 2:STE B
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480-7420
Practice Address - Country:US
Practice Address - Phone:561-248-5979
Practice Address - Fax:305-633-6332
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056675600Medicaid
FL14269OtherBCBS
FL14269BMedicare ID - Type Unspecified
FL056675600Medicaid