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General NPI Number Information
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NPI Number | 1508837352
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Entity Type | Individual
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Provider Name | PETER PAUL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 9041 MAGNOLIA AVE SUITE 105
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City | RIVERSIDE
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State | CA
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Zip | 92503-3900
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Country | US
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Telephone | 951-351-7726
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Fax |
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Provider Business Mailing Address
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Address Line | 16064 PICK PL
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City | RIVERSIDE
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State | CA
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Zip | 92504-5642
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Country | US
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Telephone | 951-780-8666
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A40030
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License Number State | CA
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