Healthcare Provider Details

I. General information

NPI: 1154479525
Provider Name (Legal Business Name): PETER JOHN MURAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 DOVE ST STE 170
NEWPORT BEACH CA
92660-1421
US

IV. Provider business mailing address

1024 BAYSIDE DR STE #212
NEWPORT BEACH CA
92660-7462
US

V. Phone/Fax

Practice location:
  • Phone: 888-315-4777
  • Fax:
Mailing address:
  • Phone: 888-315-4777
  • Fax: 805-548-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA4078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberA4078
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA4078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: