Provider Demographics
NPI:1386726545
Name:ALDANA, PETER ROQUE (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ROQUE
Last Name:ALDANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S 23RD STREET, STE 7
Mailing Address - Street 2:
Mailing Address - City:FT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950
Mailing Address - Country:US
Mailing Address - Phone:772-465-5600
Mailing Address - Fax:772-467-1050
Practice Address - Street 1:1801 S 23RD STREET, STE 7
Practice Address - Street 2:
Practice Address - City:FT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-465-5600
Practice Address - Fax:772-467-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME694652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250207100Medicaid
FLG23469Medicare UPIN
FL250207100Medicaid