Provider Demographics
NPI:1417913328
Name:STRUTZ, PETER D (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:STRUTZ
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 1:605 E ALVARADO ST
Mailing Address - Street 2:100
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-2315
Mailing Address - Country:US
Mailing Address - Phone:760-728-8489
Mailing Address - Fax:760-731-3169
Practice Address - Street 1:605 E ALVARADO ST
Practice Address - Street 2:100
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-2315
Practice Address - Country:US
Practice Address - Phone:760-728-8489
Practice Address - Fax:760-731-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47200589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G69594Medicare ID - Type Unspecified
F14980Medicare UPIN