Provider Demographics
NPI:1285740480
Name:COELHO, PETER ROBERT (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ROBERT
Last Name:COELHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2562
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95024-2562
Mailing Address - Country:US
Mailing Address - Phone:831-637-5873
Mailing Address - Fax:831-637-1290
Practice Address - Street 1:930 SUNSET DR
Practice Address - Street 2:BUILDING 1, SUITE A
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5780
Practice Address - Country:US
Practice Address - Phone:831-637-5873
Practice Address - Fax:831-637-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine