Provider Demographics
NPI:1881690089
Name:PETER, ALAN RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAYMOND
Last Name:PETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4080 LOMA VISTA ROAD
Mailing Address - Street 2:SUITE J
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1811
Mailing Address - Country:US
Mailing Address - Phone:805-658-6744
Mailing Address - Fax:805-658-7231
Practice Address - Street 1:4080 LOMA VISTA ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1811
Practice Address - Country:US
Practice Address - Phone:805-658-6744
Practice Address - Fax:805-658-7231
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28070207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28070OtherMEDICAL LICENSE
CA00G2807000Medicaid
CA953144247OtherTAX ID
CA00G2807000Medicaid