Provider Demographics
NPI:1386881282
Name:PEUGH, MICHAEL (IDC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PEUGH
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5387
Mailing Address - Country:US
Mailing Address - Phone:858-577-7675
Mailing Address - Fax:
Practice Address - Street 1:2496 BAUER RD
Practice Address - Street 2:MCAS MIRAMAR BRANCH MEDICAL CLINIC
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145
Practice Address - Country:US
Practice Address - Phone:858-577-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program