Provider Demographics
NPI:1275608127
Name:ST. PETER, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:ST. PETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:ST. PETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:710 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2748
Mailing Address - Country:US
Mailing Address - Phone:831-423-1000
Mailing Address - Fax:831-423-1000
Practice Address - Street 1:710 RIVER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2748
Practice Address - Country:US
Practice Address - Phone:831-423-1000
Practice Address - Fax:831-432-1000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0314322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G314320Medicare UPIN