Provider Demographics
NPI:1467531855
Name:SKAFF, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SKAFF
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA779342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0675706OtherCIGNA
CAMCMG244000OtherWESTERN HEALTH ADVANTAGE
CA1628167OtherGREAT WEST
CA2301376OtherUNITED HEALTHCARE
CA7717423OtherAETNA
CA099466OtherHEALTH NET
CA90133502OtherPACIFICARE
CA94393OtherINTERPLAN
CA00A779340OtherBLUE SHIELD
CA00A779340Medicaid
CA2097679OtherFIRST HEALTH
CAA77934OtherBLUE CROSS
CA2301376OtherUNITED HEALTHCARE
CA7717423OtherAETNA