Provider Demographics
NPI:1013195759
Name:MATTEI, PETER L IV (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:MATTEI
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15006 BOWFIN TER
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5819
Mailing Address - Country:US
Mailing Address - Phone:609-330-2168
Mailing Address - Fax:
Practice Address - Street 1:6600 UNIVERSITY PKWY STE 302
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-9048
Practice Address - Country:US
Practice Address - Phone:941-800-5001
Practice Address - Fax:941-800-5012
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-02351207N00000X, 207ND0101X
FLME122865207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery