Healthcare Provider Details

I. General information

NPI: 1609885888
Provider Name (Legal Business Name): PETER JOHANNET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE # 112 PAVAHCS
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE # 112 PAVAHCS
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-849-0237
Mailing address:
  • Phone: 650-493-5000
  • Fax: 650-849-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG68709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: