Provider Demographics
NPI:1366498552
Name:SIMIC, PETER JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:SIMIC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:P.
Other - Middle Name:JOHN
Other - Last Name:SIMIC
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 80116
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91716-8116
Mailing Address - Country:US
Mailing Address - Phone:800-749-4560
Mailing Address - Fax:405-751-3183
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-843-5111
Practice Address - Fax:405-751-3183
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78807207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G788070OtherBLUE SHIELD
CAG78807OtherBLUE CROSS
00G504290OtherBLUE SHIELD
CA00G788070Medicaid
G50429OtherBLUE CROSS
CAG78807OtherBLUE CROSS
WG78807CMedicare ID - Type Unspecified