Provider Demographics
NPI:1982682852
Name:SHUMAKER, PETER RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:RANDALL
Last Name:SHUMAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CTR
Mailing Address - Street 2:34800 BOB WILSON DR., STE 300
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-0001
Mailing Address - Country:US
Mailing Address - Phone:619-532-9660
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CTR
Practice Address - Street 2:34800 BOB WILSON DR., STE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-9660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99780207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology