Healthcare Provider Details

I. General information

NPI: 1629189113
Provider Name (Legal Business Name): PETER S MCCAULEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 COFFEE RD SUITE A
BAKERSFIELD CA
93308-5024
US

IV. Provider business mailing address

PO BOX 81447
BAKERSFIELD CA
93380-1447
US

V. Phone/Fax

Practice location:
  • Phone: 661-588-9999
  • Fax: 661-588-9041
Mailing address:
  • Phone: 661-588-9999
  • Fax: 661-588-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG761440
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG76144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: