Basic Information
| Provider Information | |||||||||
| NPI: | 1699746685 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELLETIER | ||||||||
| FirstName: | PIERRE | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PELLETIER | ||||||||
| OtherFirstName: | PIERRE | ||||||||
| OtherMiddleName: | ALFRED | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 34800 BOB WILSON DR | ||||||||
| Address2: | NAVAL HOSPITAL, SAN DIEGO | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921341098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 34800 BOB WILSON DRIVE | ||||||||
| Address2: | NAVAL HOSPITAL, SAN DIEGO | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921345000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 11/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | 01046759 | IN | Y | Other Service Providers | Military Health Care Provider | 2085R0202X | A72428 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.