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General NPI Number Information
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NPI Number | 1477843597
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Entity Type | Individual
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Provider Name | PETER DOUGLAS MCQUEEN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 99 MONTECILLO RD
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3308
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Country | US
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Telephone | 415-444-4430
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Fax |
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Provider Business Mailing Address
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Address Line | 99 MONTICELLO RD MOB 2, 2ND FLOOR ORTHOPAEDICS
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City | SAN RAFAEL
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-444-4430
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 036143839
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 141349
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License Number State | CA
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