Provider Demographics
NPI:1033296207
Name:ALINE, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:ALINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 OUTLET CENTER DR
Mailing Address - Street 2:#220
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0663
Mailing Address - Country:US
Mailing Address - Phone:805-988-4118
Mailing Address - Fax:805-988-1239
Practice Address - Street 1:1901 OUTLET CENTER DR
Practice Address - Street 2:#220
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0663
Practice Address - Country:US
Practice Address - Phone:805-988-4118
Practice Address - Fax:805-988-1239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG62689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG62689Medicare ID - Type Unspecified
CAE07520Medicare UPIN
CAG62689Medicare PIN