Provider Demographics
NPI:1699746685
Name:PELLETIER, PIERRE ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:ALFRED
Last Name:PELLETIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PIERRE
Other - Middle Name:ALFRED
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:NAVAL HOSPITAL, SAN DIEGO
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:619-532-6400
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DRIVE
Practice Address - Street 2:NAVAL HOSPITAL, SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046759171000000X
CAA724282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology