Provider Demographics
NPI:1255369229
Name:MONFORE, PETER HOWLAND (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:HOWLAND
Last Name:MONFORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3699
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8699
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:4950 BARRANCA PKWY
Practice Address - Street 2:104
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4709
Practice Address - Country:US
Practice Address - Phone:949-857-1248
Practice Address - Fax:949-559-1165
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00621278OtherMEDICARE RAIL ROAD
CAWG45067DMedicare PIN
CAF18082Medicare UPIN