Healthcare Provider Details

I. General information

NPI: 1982010443
Provider Name (Legal Business Name): PETER THORNHILL MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2014
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 SPRING ST
SANTA ROSA CA
95404-3901
US

IV. Provider business mailing address

719 SPRING ST
SANTA ROSA CA
95404-3901
US

V. Phone/Fax

Practice location:
  • Phone: 707-524-4690
  • Fax:
Mailing address:
  • Phone: 707-524-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA149703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: