| Provider / Organization | NPI | Date Certified |
|---|---|---|
| PETER DEAN POULLOS | 1740478395 | 2024-04-07 |
Peter D Poullos [M] graduated in 1999 and primarily specializes in Diagnostic Radiology.
Peter Dean Poullos is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1740478395. Registration indicates Peter Dean Poullos is a provider of services with a specialization in Diagnostic Radiology (Radiology) (Allopathic & Osteopathic Physicians, Radiology) (Radiology: Diagnostic Radiology, ) (Diagnostics/Imaging/Laboratory/Mammography, ) (Radiology Diagnostic Radiology, Allopathic & Osteopathic Physicians) (Radiology, ) (Allopathic & Osteopathic Physicians, Radiology) (Radiology: Body Imaging, ) (Radiology Body Imaging, Allopathic & Osteopathic Physicians) (Radiology, )
| PECOS ID | 6103994447 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Peter Dean Poullos M.D. |
| Practice Office Address | 300 PASTEUR DR STANFORD, CA US |
| Practice Office Telephone | 6507234000 |
| Mailing Address | 300 PASTEUR DR STANFORD, CA 943052200 US |
| Business Telephone | 6507234000 |
| Code | Practice | License No State |
|---|---|---|
| 2085R0202X | Diagnostic Radiology (Radiology), Allopathic & Osteopathic Physicians Radiology Radiology: Diagnostic Radiology Diagnostics/Imaging/Laboratory/Mammography Radiology Diagnostic Radiology Allopathic & Osteopathic Physicians Radiology | A73516
CA |
| 2085B0100X PRIMARY | Allopathic & Osteopathic Physicians Radiology Radiology: Body Imaging Radiology Body Imaging Allopathic & Osteopathic Physicians Radiology | A73516
CA |
| 113678 | OTHER | CA | UPIN |
| 00A869820 | MEDICAID | CA |