Provider Demographics
NPI:1457400558
Name:PETER BALES, M.D., INC.
Entity Type:Organization
Organization Name:PETER BALES, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-788-8201
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-0044
Mailing Address - Country:US
Mailing Address - Phone:916-788-8201
Mailing Address - Fax:916-788-8205
Practice Address - Street 1:1613 EUREKA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3029
Practice Address - Country:US
Practice Address - Phone:916-788-8201
Practice Address - Fax:916-788-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63997207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G639970Medicaid
CA1669568994OtherINDIVIDUAL PROVIDER NPI
CA00G639970Medicaid
CAF41031Medicare UPIN