Provider Demographics
NPI:1336117217
Name:LOMBARD, PETER N (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:N
Last Name:LOMBARD
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 1:736 ROUTE 4 STE 202
Mailing Address - Street 2:
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-3368
Mailing Address - Country:US
Mailing Address - Phone:671-989-4747
Mailing Address - Fax:
Practice Address - Street 1:736 ROUTE 4 STE 103
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910-3368
Practice Address - Country:US
Practice Address - Phone:671-989-4747
Practice Address - Fax:671-989-4743
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
HI12540207W00000X
GU1687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUHC068ZMedicare PIN