Provider Demographics
NPI:1467579342
Name:ECKMAN, PETER ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROBERT
Last Name:ECKMAN
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 1:3507 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3539
Mailing Address - Country:US
Mailing Address - Phone:415-648-1971
Mailing Address - Fax:415-550-0620
Practice Address - Street 1:3507 ALMA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3539
Practice Address - Country:US
Practice Address - Phone:650-493-2048
Practice Address - Fax:415-550-0620
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25447208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G254471Medicare ID - Type Unspecified
CA00G254470Medicare ID - Type Unspecified