Healthcare Provider Details

I. General information

NPI: 1477752202
Provider Name (Legal Business Name): GERALD E. PETERS, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N 1ST ST SUITE 131
FRESNO CA
93710-3900
US

IV. Provider business mailing address

101 E REDLANDS BLVD SUITE 212
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-3333
  • Fax: 559-432-3336
Mailing address:
  • Phone: 909-335-8649
  • Fax: 909-557-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC23618
License Number StateCA

VIII. Authorized Official

Name: J. ROBERT WEST
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-335-8649