MEDICARE: DR. PETER ANTHONY WAWRO M.D.

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	2086S0127X	Trauma Surgery Physician	G44719	CA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	G44719	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	:	1487691051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANTHONY WAWRO M.D.

Provider Business Mailing Address
First Line	:	801 N TUSTIN AVE
Second Line	:	SUITE 305
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3612
Country	:	US
Telephone Number	:	714-953-4442
Fax Number	:	714-564-0399

Provider Business Practice Location Address
First Line	:	801 N TUSTIN AVE
Second Line	:	SUITE 305
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3612
Country	:	US
Telephone Number	:	714-953-4442
Fax Number	:	714-564-0399

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/08/2007

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