Individual
PETER DEAN POULLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
A73516
CA
2085R0202X
Diagnostic Radiology Physician
A73516
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A869820
—
CA
01
—
113678
UPIN
CA
Enumeration date
10/09/2007
Last updated
04/07/2024
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