Provider Demographics
NPI:1164457776
Name:PERALTA, JUAN OBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:OBAR
Last Name:PERALTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E SUNBURY ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-4823
Mailing Address - Country:US
Mailing Address - Phone:570-644-0918
Mailing Address - Fax:
Practice Address - Street 1:141 E SUNBURY ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-4823
Practice Address - Country:US
Practice Address - Phone:570-644-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014429E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology