Provider Demographics
NPI:1790777019
Name:TERNUS, PETER A (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:TERNUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13847 E 14TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2626
Mailing Address - Country:US
Mailing Address - Phone:510-351-7552
Mailing Address - Fax:510-351-6009
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:STE 210
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2626
Practice Address - Country:US
Practice Address - Phone:510-351-7552
Practice Address - Fax:510-351-6009
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA94-3283987213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6234650001Medicare NSC