Provider Demographics
NPI:1578636593
Name:NEBLETT, PETER P (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:P
Last Name:NEBLETT
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 1:5515 PACIFIC ST
Mailing Address - Street 2:#2582
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4805
Mailing Address - Country:US
Mailing Address - Phone:916-316-2765
Mailing Address - Fax:530-878-0335
Practice Address - Street 1:1 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-316-2765
Practice Address - Fax:530-878-0335
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC18010207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C180100Medicaid
CA00C18010OtherBLUECROSS BLUESHIELD
CA20018012OtherRAILROAD MEDICARE
CA264040027OtherTRICARE
CAA31163Medicare UPIN
CA00C180100Medicare ID - Type Unspecified