Provider Demographics
NPI:1568522035
Name:SHIN, PETER C (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:SHIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MSC 10 5615
Mailing Address - Street 2:1 UNIVERESITY OF NEW MEXICO
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-3401
Mailing Address - Fax:505-272-6901
Practice Address - Street 1:MSC 10 5615
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3401
Practice Address - Fax:505-272-6091
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-07-21
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Provider Licenses
StateLicense IDTaxonomies
WAMD00040264207T00000X
NMMD2013-0879207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0150866OtherL&I NUMBER
WAGAB27669Medicare PIN
WAG82299Medicare UPIN