Provider Demographics
NPI:1588748768
Name:DUMONT, PEASLEE FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:PEASLEE
Middle Name:FREDERICK
Last Name:DUMONT
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 1:313 KENDAL ST
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3960
Mailing Address - Country:US
Mailing Address - Phone:707-447-7751
Mailing Address - Fax:707-447-7084
Practice Address - Street 1:313 KENDAL ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3960
Practice Address - Country:US
Practice Address - Phone:707-447-7751
Practice Address - Fax:707-447-7084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G347780Medicaid
A46076Medicare UPIN
CA00G347780Medicaid