MEDICARE: PETER GEORGE MAY PA-S

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	PA55619	CA

General Provider Information

NPI Number	:	1457864597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER GEORGE MAY PA-S

Provider Business Mailing Address
First Line	:	2100 POWELL ST STE 400
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-350-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2365 SUNSET DR
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-4651
Country	:	US
Telephone Number	:	805-458-6255
Fax Number	:

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

Provider Enumeration Date	:	11/12/2017
Last Update Date	:	07/22/2019

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