Provider Demographics
NPI:1639105554
Name:RUTTER, PETER LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LEWIS
Last Name:RUTTER
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 1:205 CAMINO ALTO CT
Mailing Address - Street 2:STE 240
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4312
Mailing Address - Country:US
Mailing Address - Phone:415-383-4900
Mailing Address - Fax:415-503-9727
Practice Address - Street 1:205 CAMINO ALTO CT
Practice Address - Street 2:STE 240
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4312
Practice Address - Country:US
Practice Address - Phone:415-383-4900
Practice Address - Fax:415-503-9727
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG203042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACO745ZMedicare PIN
CACO745AMedicare PIN
NY91M381Medicare ID - Type Unspecified