Individual
PETER FORD KNICKERBOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND, JACKSONVILLE, FL 32212-0140
(215) 298-2476
Mailing address
3435 GURNARD CT, SAN DIEGO, CA 92124-3304
(215) 298-2476
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
20A12420
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/19/2011
Last updated
03/23/2023
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