DR. VINCENT GLENN PETERSON (NPI# 1487887295) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487887295 |
| Entity Type | Individual |
| Full Name | DR. VINCENT GLENN PETERSON |
| Credential | D.O. |
| Practice Address |
695 N Clyde Morris Blvd Daytona Beach FL 32114-2321 |
| Practice Telephone | 3862588722 |
| Practice Fax Number | 3862589443 |
| Mailing Telephone | 3862588722 |
| Mailing Fax Number | 3862589443 |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2017-12-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
OS14032 | FL | Allopathic & Osteopathic Physicians |
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
OS14032 | FL | Allopathic & Osteopathic Physicians |
| N | 207UN0901X |
Nuclear Medicine Specialization: Nuclear Cardiology |
OS14032 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS FL | 88976 | 01 |
| FL | 278018600 | 05 |
| Street Address |
695 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548239874 | Theresa Ann Purcell | Nurse Practitioner | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-03-17 |
| 1750514154 | Umang Lalit Shah | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-09-01 |
| 1467643213 | Pedro Rafael Cox-alomar | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-08-07 |
| 1528266939 | Roger K Lewis | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-07-06 |
| 1346457876 | Cynthia C. Davenport | Physician Assistant | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-05-16 |
| 1891907671 | Nancy S Mather | Nurse Practitioner | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-05-04 |
| 1245363423 | Atlantic Cardiology Enterprises, Inc. | Nuclear Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2007-03-14 |
| 1669589263 | Lewis & Klancke Cardiology Pa | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-08-23 |
| 1316902612 | Glenn Hidalgo Rayos | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114 | 2006-04-19 |
| 1194788117 | Barry Allen Kusnick | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2006-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245286624 | Otakar Quadrat | Internal Medicine | 311 N Clyde Morris Blvd, Suite 320, Daytona Beach, FL 32114-2781 | 2006-05-26 |
| 1831142470 | Heart Group Pa | Internal Medicine | 311 N Clyde Morris Blvd, Suite 310, Daytona Beach, FL 32114-2781 | 2006-05-17 |
| 1720040488 | Mark Bernard Barettella | Internal Medicine | 311 N Clyde Morris Blvd, Ste 310, Daytona Beach, FL 32114 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861004277 | Steve Malosky Md LLC | Internal Medicine | 900 Sw Saint Lucie Cres, Stuart, FL 34994-2842 | 2020-08-18 |
| 1881212744 | North Broward Hospital District | Internal Medicine | 817 S University Dr Ste 104, Plantation, FL 33324-3345 | 2020-07-08 |
| 1821612821 | Satish Sivasankaran Md Pa | Internal Medicine | 5340 Gulf Dr Ste 101, New Port Richey, FL 34652-3922 | 2020-06-04 |
| 1699317933 | Abid A Shah Md LLC | Internal Medicine | 5741 Bee Ridge Rd Ste 420, Sarasota, FL 34233-5081 | 2019-10-08 |
| 1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
| 1205329620 | Central Florida Cardiovascular Imaging Center, LLC | Internal Medicine | 1717 Mayo Dr, Tavares, FL 32778-4307 | 2018-06-11 |
| 1568953511 | Orlando Lopez-fernandez Jr. | Internal Medicine | 2800 Ponce De Leon Blvd Ste 1480, Coral Gables, FL 33134-6921 | 2018-05-25 |
| 1467959668 | Cardiology Practice Pa | Internal Medicine | 5051 Ashington Landing Dr, Tampa, FL 33647-3515 | 2018-04-12 |
| 1619476785 | Synergy Health Group LLC | Internal Medicine | 7828 Collins Grove Rd, Jacksonville, FL 32256-7175 | 2018-02-05 |
| 1114425477 | Cardiac Cin of Miami LLC | Internal Medicine | 2 S Biscayne Blvd Ste 3760c, Miami, FL 33131-1815 | 2018-01-31 |
| Find all providers with the same taxonomy | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.