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Individual

PETER S UZELAC

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1100 S ELISEO DR STE 107, ATTN: JAIMIE VIGIL, GREENBRAE, CA 94904-2017
(415) 925-9404
(415) 484-7045
Mailing address
1100 S ELISEO DR STE 107, ATTN: JAIMIE VIGIL, GREENBRAE, CA 94904-2017
(415) 925-9404
(415) 484-7045

Taxonomy

Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
A72448
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000480316
ANTHEM PSC
KY
05
200878600
IN
01
50011330
PASSPORT SPECIALITY PSC
KY
01
50011331
PASSPORT SPECIALITY- FOUNDATION
KY
01
50011332
PASSPORT PCP FOUNDATION
KY
05
64120736
KY
Enumeration date
06/13/2005
Last updated
02/05/2014
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