Provider Demographics
NPI:1821049230
Name:HOLMAN, PETER R (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:HOLMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:MOORES UCSD CANCER CENTER
Mailing Address - Street 2:3855 HEALTH SCIENCES DRIVE #0960
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0960
Mailing Address - Country:US
Mailing Address - Phone:858-822-6600
Mailing Address - Fax:858-822-6844
Practice Address - Street 1:UCSD MEDICAL CENTER
Practice Address - Street 2:200 WEST ARBOR DRIVE MC 8201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:858-657-8570
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA63150207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A631500Medicaid
CAG67546Medicare UPIN
CA00A631500Medicaid