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General NPI Number Information
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NPI Number | 1659674653
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Entity Type | Organization
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Legal Business Name | PETER B A PAPPAS MD INC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 76 BROOKWOOD AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-4312
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Country | US
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Telephone | 707-523-2381
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Fax | 707-523-2469
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Provider Business Mailing Address
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Address Line | 76 BROOKWOOD AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-4312
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Country | US
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Telephone | 707-523-2381
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Fax | 707-523-2469
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Authorized Official
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Title or Position | MANAGER
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Name | MISS SOPHIE PAPPAS
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Credential |
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Telephone | 415-785-7019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G74506
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License Number State | CA
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