Provider Demographics
NPI:1043357122
Name:TENG, PETER (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:TENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:TENG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:523 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3812
Mailing Address - Country:US
Mailing Address - Phone:305-696-5088
Mailing Address - Fax:305-696-5063
Practice Address - Street 1:523 E 25TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3812
Practice Address - Country:US
Practice Address - Phone:305-696-5088
Practice Address - Fax:305-696-5063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64466207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374682800Medicaid
FLBT3721811OtherDEA
18971Medicare ID - Type Unspecified