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NPI Code Detail

MEDICARE: PETER J LEIDL MD

MEDICARE: PETER J LEIDL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA41675CA
2207RG0300XGeriatric Medicine (Internal Medicine) PhysicianA41675CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A416750OTHERCAMEDI CAL

General Provider Information

NPI Number : 1447257688
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER J LEIDL MD
Provider Business Mailing Address
First Line : 2801 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-1701
Country : US
Telephone Number : 562-933-2000
Fax Number :
Provider Business Practice Location Address
First Line : 2801 ATLANTIC AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-1701
Country : US
Telephone Number : 562-933-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/22/2015

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Directions to “ PETER J LEIDL MD” Practice Location

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