Healthcare Provider Details

I. General information

NPI: 1518912526
Provider Name (Legal Business Name): PETER STOOPS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 PHELAN RD SUITE F1
PHELAN CA
92371-4141
US

IV. Provider business mailing address

12370 HESPERIA RD SUITE 6
VICTORVILLE CA
92395-7719
US

V. Phone/Fax

Practice location:
  • Phone: 760-868-6622
  • Fax: 760-868-2505
Mailing address:
  • Phone: 760-245-4747
  • Fax: 760-269-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: