Provider Demographics
NPI:1669498622
Name:NASSAR, PETER THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THEODORE
Last Name:NASSAR
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 1:6121 N THESTA ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8603
Mailing Address - Country:US
Mailing Address - Phone:559-450-2300
Mailing Address - Fax:559-450-2392
Practice Address - Street 1:6121 N THESTA ST
Practice Address - Street 2:SUITE 303
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8603
Practice Address - Country:US
Practice Address - Phone:559-450-2300
Practice Address - Fax:559-450-2392
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80372207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A803720Medicaid
CAI04294Medicare UPIN
CAI04294Medicare UPIN