Provider Demographics
NPI:1295999647
Name:PETER JOSON M.D. INC
Entity type:Organization
Organization Name:PETER JOSON 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:JOSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-489-2218
Mailing Address - Street 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-489-2218
Mailing Address - Fax:949-496-3604
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-489-2218
Practice Address - Fax:949-496-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83538207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty