Provider Demographics
NPI:1003013889
Name:MAYLAND, PETER GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GLEN
Last Name:MAYLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10021 MADRONE LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95470-9724
Mailing Address - Country:US
Mailing Address - Phone:707-485-0770
Mailing Address - Fax:707-485-6111
Practice Address - Street 1:10021 MADRONE LN
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9724
Practice Address - Country:US
Practice Address - Phone:707-485-0770
Practice Address - Fax:707-485-6111
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG229232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry