Provider Demographics
NPI:1033193099
Name:ROSENQUIST, PETER BECHAN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:BECHAN
Last Name:ROSENQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY, SUITE 1400
Mailing Address - Street 2:ATTN: DONNA RAIFORD
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-828-8401
Mailing Address - Fax:
Practice Address - Street 1:997 SAINT SEBASTIAN WAY
Practice Address - Street 2:GEORGIA REGENTS MEDICAL ASSOCIATES
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-721-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0682962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125892AMedicaid
GA068296OtherLICENSE
GA068296OtherLICENSE
GA003125892AMedicaid
GA20226I6483Medicare PIN
SCQ34145Medicaid
40096OtherMEDCOST
73195OtherBCBS
260050045OtherRR MEDICARE