Provider Demographics
NPI:1316035082
Name:HUGH, PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 E. SOUTH ST.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712
Mailing Address - Country:US
Mailing Address - Phone:562-602-8841
Mailing Address - Fax:562-602-8843
Practice Address - Street 1:3650 E. SOUTH ST.
Practice Address - Street 2:SUITE 204
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712
Practice Address - Country:US
Practice Address - Phone:562-602-8841
Practice Address - Fax:562-602-8843
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60050Medicaid
CAE67732Medicare UPIN
CAW15777Medicare PIN