Provider Demographics
NPI:1669545141
Name:STEFFEN, PETER (DPM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STEFFEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2755
Mailing Address - Country:US
Mailing Address - Phone:831-642-0779
Mailing Address - Fax:831-372-7516
Practice Address - Street 1:505 CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2755
Practice Address - Country:US
Practice Address - Phone:831-642-0779
Practice Address - Fax:831-372-7516
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4361119Medicaid
CA4361119Medicaid
CAT11691Medicare UPIN