Provider Demographics
NPI:1528228798
Name:PETERO, VIRGILIO GARCIA JR (MD)
Entity Type:Individual
Prefix:
First Name:VIRGILIO
Middle Name:GARCIA
Last Name:PETERO
Suffix:JR
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 1:633 CARLOS CAMACHO RD SUITE 210
Mailing Address - Street 2:GUAM MEDICAL PLAZA, GUAM RADIOLOGY CONSULTANTS
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:671-649-1009
Practice Address - Street 1:633 CARLOS CAMACHO RD SUITE 210
Practice Address - Street 2:GUAM MEDICAL PLAZA, GUAM RADIOLOGY CONSULTANTS
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:671-649-1009
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology