Provider Demographics
NPI:1194999334
Name:DORIAN, PETER JOHN (MA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:DORIAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 N FRESNO ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6853
Mailing Address - Country:US
Mailing Address - Phone:559-224-1344
Mailing Address - Fax:559-224-3814
Practice Address - Street 1:5180 N FRESNO ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6853
Practice Address - Country:US
Practice Address - Phone:559-224-1344
Practice Address - Fax:559-224-3814
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU244231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07629ZOtherMEDICARE INDIVIDUAL TRANSACTION ACCESS NUMBER
CAZZZ07630ZOtherMEDICARE GROUP TRANSACTION ACCESS NUMBER
CAZZZ75041ZMedicaid
CAR22235Medicare UPIN
CAZZZ07630ZOtherMEDICARE GROUP TRANSACTION ACCESS NUMBER