Basic Information
| Provider Information | |||||||||
| NPI: | 1558510248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DAVID GRANT MEDICAL CENTER | ||||||||
| Address2: | 101 BODIN CIR | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 BODIN CIR | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | TRAVIS AFB | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945351809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074233735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0072607 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 0101246777 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 247654 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A126358 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.