Provider Demographics
NPI:1841411758
Name:VANHOUTEN, PETER DEMEREST (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:DEMEREST
Last Name:VANHOUTEN
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 1:14618 TYLER FOOTE RD. #111
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9318
Mailing Address - Country:US
Mailing Address - Phone:530-478-7763
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:15301 TYLER FOOTE RD.
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43114208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89774Medicare UPIN
CA551863Medicare ID - Type Unspecified