Provider Demographics
NPI:1619650256
Name:LEAR, BO PENG (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BO
Middle Name:PENG
Last Name:LEAR
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:BO
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:500 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1048
Mailing Address - Country:US
Mailing Address - Phone:240-446-4425
Mailing Address - Fax:
Practice Address - Street 1:500 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1048
Practice Address - Country:US
Practice Address - Phone:240-446-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL15375207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPTL15375OtherCALIFORNIA POSTGRADUATE TRAINING LICENSE NUMBER