Provider Demographics
NPI:1962557447
Name:BENEDICT, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:CA
Mailing Address - Zip Code:93440-0463
Mailing Address - Country:US
Mailing Address - Phone:805-705-1880
Mailing Address - Fax:
Practice Address - Street 1:114 E HALEY ST
Practice Address - Street 2:STE D
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2347
Practice Address - Country:US
Practice Address - Phone:805-962-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295817302Medicare UPIN