Basic Information
| Provider Information | |||||||||
| NPI: | 1225200116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERVIE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5924 AUVERS BLVD | ||||||||
| Address2: | UNIT 104 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328073764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016965881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 844 N THORNTON AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078948768 | ||||||||
| FaxNumber: | 4078946872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 234619 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | ME110130 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | ME110130 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000379580 | 05 | FL | MEDICAID | 003795800 | 05 | FL | MEDICAID |