Healthcare Provider Details

I. General information

NPI: 1164598207
Provider Name (Legal Business Name): PETER M SEYMOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 GIRARD AVE STE 200
LA JOLLA CA
92037-4430
US

IV. Provider business mailing address

7777 GIRARD AVE STE 200
LA JOLLA CA
92037-4430
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1788
  • Fax: 858-576-0610
Mailing address:
  • Phone: 858-352-6009
  • Fax: 858-352-6163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG49897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: