Selassie, Peter G
Selassie, Peter G is an individual health care provider with primary practice located at 1061 Medical Center Dr Suite 110, Orange City FL 32763-8200. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Selassie, Peter G can be contacted via phone (386) 774-1223.Contact Information
Primary practice address
1061 Medical Center Dr Suite 110
Orange City FL 32763-8200
Phone: (386) 774-1223
Fax: (386) 774-4658
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | ME36870 | Florida |
Profile Details
| NPI number | 1346298759 |
|---|---|
| LBN Legal business name | Selassie, Peter G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 5th, 2006 |
| Last updated | Apr 23rd, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346298759 | NPPES |
| Florida | MEDICAID | 069666800 |
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