Provider Demographics
NPI:1164472247
Name:CANADAY, PETER G (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:CANADAY
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 1:706 E SAINT ANDREWS CIR
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5111
Mailing Address - Country:US
Mailing Address - Phone:720-951-3502
Mailing Address - Fax:
Practice Address - Street 1:706 E SAINT ANDREWS CIR
Practice Address - Street 2:PETER CANADAY MD PC
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5111
Practice Address - Country:US
Practice Address - Phone:720-951-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO237132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01237130Medicaid
COP00621387Medicare PIN
COC801578Medicare PIN
COC801370Medicare PIN
COP00641735Medicare PIN
COC803975Medicare PIN
COC801369Medicare PIN
COC801577Medicare PIN
COC809549Medicare PIN