MARY KAY PETERSON MD NPI 1508805656

NPI Information

NPI: 1508805656
Provider Name: MARY KAY PETERSON, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

Organization: RADIOLOGY REGIONAL CENTER PA

PECOS Registration: Yes

Address:
3680 BROADWAY
FORT MYERS, FL
ZIP 33901
Phone: (239) 936-2316
Get Directions

Mary Kay Peterson, MD is a diagnostic radiology radiology in Fort Myers, FL with 31 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Mary Kay Peterson, MD NPI is 1508805656. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Graduation Year:1993

The provider's business location address is:

3680 BROADWAY
FORT MYERS, FL
ZIP 33901-005
Phone: (239) 936-2316

The NPI 1508805656 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/5/2006 and was last updated on 5/29/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	ME77132	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7405122	OTHER		AETNA PPO
2	257739900	MEDICAID	FLORIDA
3	46568	OTHER		BCBS
4	300112784	MEDICARE PIN
5	G96077	MEDICARE UPIN
6	46568A	MEDICARE PIN	FLORIDA
7	2439859	OTHER		AETNA HMO
8	ME77132	OTHER	FLORIDA	FLORIDA LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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