Provider Demographics
NPI:1770746646
Name:PETER FISCHL, MD, INC.
Entity type:Organization
Organization Name:PETER FISCHL, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-242-0762
Mailing Address - Street 1:16130 KOKANEE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0833
Mailing Address - Country:US
Mailing Address - Phone:760-242-0762
Mailing Address - Fax:760-242-1803
Practice Address - Street 1:16130 KOKANEE RD
Practice Address - Street 2:STE 104
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0833
Practice Address - Country:US
Practice Address - Phone:760-242-0762
Practice Address - Fax:760-242-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA335802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335801Medicaid
CAA27189Medicare UPIN
CA00A335800Medicare PIN