Provider Demographics
NPI:1538473426
Name:PEROUTKA, STEPHEN JOSEPH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:PEROUTKA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26339 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-9102
Mailing Address - Country:US
Mailing Address - Phone:831-621-4044
Mailing Address - Fax:
Practice Address - Street 1:26339 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-9102
Practice Address - Country:US
Practice Address - Phone:831-621-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG530682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology