Provider Demographics
NPI:1083939110
Name:READ, PETER THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:THOMAS
Last Name:READ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4019
Mailing Address - Fax:
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IADO-04391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP01353133OtherRR MEDICARE
IA1083939110Medicaid
IAP01353133OtherRR MEDICARE