Provider Demographics
NPI:1578652764
Name:JOSON, PETER JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JONATHAN
Last Name:JOSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:STE 107
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-489-2218
Mailing Address - Fax:949-496-3604
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:STE 107
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-489-2218
Practice Address - Fax:949-496-3604
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83538207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH70038Medicare UPIN
CAW19668Medicare ID - Type Unspecified