MEDICARE: PETER BALES, M.D., INC.

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
1	207X00000X	Orthopaedic Surgery Physician	G63997	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1669568994	OTHER	CA	INDIVIDUAL PROVIDER NPI

General Provider Information

NPI Number	:	1457400558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER BALES, M.D., INC.

Provider Business Mailing Address
First Line	:	PO BOX 44
Second Line	:
City	:	LOOMIS
State	:	CA
Zip	:	95650-0044
Country	:	US
Telephone Number	:	916-788-8201
Fax Number	:	916-788-8205

Provider Business Practice Location Address
First Line	:	1613 EUREKA RD
Second Line	:	SUITE 100
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3029
Country	:	US
Telephone Number	:	916-788-8201
Fax Number	:	916-788-8205

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER BALES
Credential	:	M.D.
Telephone Number	:	916-788-8201

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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