Healthcare Provider Details

I. General information

NPI: 1730165044
Provider Name (Legal Business Name): PETER RIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR RHEUMATOLOGY
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

1972 LA CORSO CT
WALNUT CREEK CA
94598-2215
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1075
  • Fax:
Mailing address:
  • Phone: 301-502-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC54885
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101235252
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101235252
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC54885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: