Healthcare Provider Details

I. General information

NPI: 1639286974
Provider Name (Legal Business Name): PETROS GHERMAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

IV. Provider business mailing address

23370 ROAD 22 P.O. BOX 1501
CHOWCHILLA CA
93610-8504
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax: 559-665-6078
Mailing address:
  • Phone: 559-665-5531
  • Fax: 559-665-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA63293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: