MEDICARE: MATTHEW J PELTZ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A6384	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174537104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J PELTZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 994032
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96099-4032
Country	:	US
Telephone Number	:	530-241-0473
Fax Number	:	530-241-5377

Provider Business Practice Location Address
First Line	:	1832 BUENAVENTURA BLVD
Second Line	:	STE C
City	:	REDDING
State	:	CA
Zip	:	96001-3700
Country	:	US
Telephone Number	:	530-229-1310
Fax Number	:	530-229-1312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/11/2022

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