Healthcare Provider Details

I. General information

NPI: 1699746685
Provider Name (Legal Business Name): PIERRE ALFRED PELLETIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PIERRE ALFRED PELLETIER MD

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DRIVE NAVAL HOSPITAL, SAN DIEGO
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

34800 BOB WILSON DR NAVAL HOSPITAL, SAN DIEGO
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 619-532-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01046759
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA72428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: