Provider Demographics
NPI:1285884098
Name:PETER, ANISH THOMAS (ANISH PETER)
Entity type:Individual
Prefix:DR
First Name:ANISH
Middle Name:THOMAS
Last Name:PETER
Suffix:
Gender:M
Credentials:ANISH PETER
Other - Prefix:DR
Other - First Name:ANISH
Other - Middle Name:THOMAS
Other - Last Name:PETER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2175 PARK PL
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4705
Mailing Address - Country:US
Mailing Address - Phone:310-354-4346
Mailing Address - Fax:469-294-0993
Practice Address - Street 1:2175 PARK PL
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4705
Practice Address - Country:US
Practice Address - Phone:310-354-4346
Practice Address - Fax:469-294-0993
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR71060390200000X
AZ50855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program