Provider Demographics
NPI:1164566477
Name:JUNGWIRTH, PETER SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:SCOTT
Last Name:JUNGWIRTH
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 1:30111 NIGUEL RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2260
Mailing Address - Country:US
Mailing Address - Phone:949-495-4524
Mailing Address - Fax:
Practice Address - Street 1:30111 NIGUEL RD
Practice Address - Street 2:SUITE H
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2260
Practice Address - Country:US
Practice Address - Phone:949-495-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47721Medicare PIN
CAA50787Medicare UPIN