Provider Demographics
NPI:1487691051
Name:WAWRO, PETER ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:WAWRO
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 1:801 N TUSTIN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3612
Mailing Address - Country:US
Mailing Address - Phone:714-953-4442
Mailing Address - Fax:714-564-0399
Practice Address - Street 1:801 N TUSTIN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3612
Practice Address - Country:US
Practice Address - Phone:714-953-4442
Practice Address - Fax:714-564-0399
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG447192086S0127X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447191Medicaid
CAE92674Medicare UPIN
CAG44719Medicare ID - Type UnspecifiedMEDICARE