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NPI Code Detail

MEDICARE: DR. PETER DEMEREST VANHOUTEN M.D.

MEDICARE: DR. PETER DEMEREST VANHOUTEN M.D.
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
1208D00000XGeneral Practice PhysicianG43114CA

General Provider Information

NPI Number : 1841411758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETER DEMEREST VANHOUTEN M.D.
Provider Business Mailing Address
First Line : 14618 TYLER FOOTE RD. #111
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-9318
Country : US
Telephone Number : 530-478-7763
Fax Number : 530-292-4296
Provider Business Practice Location Address
First Line : 15301 TYLER FOOTE RD.
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-9318
Country : US
Telephone Number : 530-292-3478
Fax Number : 530-292-4296
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 09/09/2020

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Directions to “ DR. PETER DEMEREST VANHOUTEN M.D.” Practice Location

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