Provider Demographics
NPI:1528078516
Name:FIELDS, PETER ALAN (MD,DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BROADWAY STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2910
Mailing Address - Country:US
Mailing Address - Phone:310-453-1234
Mailing Address - Fax:
Practice Address - Street 1:2020 BROADWAY STE A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2910
Practice Address - Country:US
Practice Address - Phone:310-453-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-01-17
Deactivation Date:2006-08-22
Deactivation Code:
Reactivation Date:2006-09-15
Provider Licenses
StateLicense IDTaxonomies
CAA80579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4583OtherSTATE CHIROPRACTIC LICENSE
CA16373OtherSTATE CHIROPRACTIC LICENSE
CAA80579OtherSTATE MEDICAL LICENSE