Provider Demographics
NPI:1467640953
Name:RUANE, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:RUANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4667
Mailing Address - Country:US
Mailing Address - Phone:323-954-1072
Mailing Address - Fax:323-954-1081
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:323-954-1072
Practice Address - Fax:323-954-1081
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2013-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA42947207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA42947CMedicare PIN