Provider Demographics
NPI:1730254988
Name:GEDDES, PETER G (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:GEDDES
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 1:705 W LA VETA AVE
Mailing Address - Street 2:#115
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4402
Mailing Address - Country:US
Mailing Address - Phone:714-535-7413
Mailing Address - Fax:714-535-7420
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:#115
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-535-7413
Practice Address - Fax:714-535-7420
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39881207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G398810Medicaid
CAA48003Medicare UPIN
CAG39881AMedicare ID - Type Unspecified