Provider Demographics
NPI:1184721284
Name:PETER PARKER, M.D. INC.
Entity type:Organization
Organization Name:PETER PARKER, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-276-4715
Mailing Address - Street 1:414 N CAMDEN DR STE 975
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4541
Mailing Address - Country:US
Mailing Address - Phone:310-276-4715
Mailing Address - Fax:310-276-4634
Practice Address - Street 1:1100 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2606
Practice Address - Country:US
Practice Address - Phone:818-546-2626
Practice Address - Fax:818-546-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44924207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0102210Medicaid
CAW17807AMedicare ID - Type UnspecifiedGROUP - GLENDALE
CAW17807AMedicare PIN