Basic Information
Provider Information
NPI: 1023079902
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEADE
FirstName: PETER
MiddleName: C.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 W HOSPITAL RD
Address2:  
City: FRENCH CAMP
State: CA
PostalCode: 952319693
CountryCode: US
TelephoneNumber: 2094686000
FaxNumber:  
Practice Location
Address1: 500 W HOSPITAL RD
Address2:  
City: FRENCH CAMP
State: CA
PostalCode: 95231
CountryCode: US
TelephoneNumber: 2094686000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2006
LastUpdateDate: 05/13/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XG57811CAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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