Healthcare Provider Details

I. General information

NPI: 1821049230
Provider Name (Legal Business Name): PETER R HOLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSD MEDICAL CENTER 200 WEST ARBOR DRIVE MC 8201
SAN DIEGO CA
92103-8201
US

IV. Provider business mailing address

MOORES UCSD CANCER CENTER 3855 HEALTH SCIENCES DRIVE #0960
LA JOLLA CA
92093-0960
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8570
  • Fax: 619-543-3183
Mailing address:
  • Phone: 858-822-6600
  • Fax: 858-822-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA63150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: