Provider Demographics
NPI:1164598207
Name:SEYMOUR, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:SEYMOUR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7777 GIRARD AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4430
Mailing Address - Country:US
Mailing Address - Phone:858-352-6009
Mailing Address - Fax:858-352-6163
Practice Address - Street 1:7777 GIRARD AVE
Practice Address - Street 2:STE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4430
Practice Address - Country:US
Practice Address - Phone:858-576-1788
Practice Address - Fax:858-576-0610
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2019-05-21
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Provider Licenses
StateLicense IDTaxonomies
CAG498972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G498970Medicaid
A98080Medicare UPIN
CA00G498970Medicaid