Basic Information
| Provider Information | |||||||||
| NPI: | 1023002979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULLER | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 BELFORT RD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322566017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044463451 | ||||||||
| FaxNumber: | 9044463013 | ||||||||
| Practice Location | |||||||||
| Address1: | 244 SMITH CHURCH RD | ||||||||
| Address2: | BUILDING 5 | ||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278704956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525352350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 39203 | NC | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 39203 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 41517 | 01 | NC | MEDCOST | OTHER | 1143058 | 01 | NC | CIGNA HEALTHCARE | OTHER | 20024554 | 01 | NC | RAILROAD MEDICARE | OTHER | 8961326 | 05 | NC | MEDICAID | 61326 | 01 | NC | BCBSNC | OTHER |