Healthcare Provider Details

I. General information

NPI: 1841305000
Provider Name (Legal Business Name): PETER WESLEY CORRIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

PO BOX 60259
LOS ANGELES CA
90060-0259
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-3445
  • Fax: 626-397-5643
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG48828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: