Provider Demographics
NPI:1609825256
Name:FRIEND, PETER SAYRE (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:SAYRE
Last Name:FRIEND
Suffix:
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 1:6480 DWANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3925
Mailing Address - Country:US
Mailing Address - Phone:619-698-8971
Mailing Address - Fax:619-466-3375
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-453-9460
Practice Address - Fax:858-453-6683
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22253207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G222530Medicaid
CAA41521Medicare UPIN
CA00G222530Medicaid