Healthcare Provider Details

I. General information

NPI: 1053574947
Provider Name (Legal Business Name): PETER JOHN GEORGIO II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 W BIRCH AVE
FRESNO CA
93711-0442
US

IV. Provider business mailing address

155 N FRESNO ST
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-8515
  • Fax:
Mailing address:
  • Phone: 559-499-6450
  • Fax: 559-499-6451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: