Provider Demographics
NPI:1174845408
Name:MACDONALD, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 SHOORESIN CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1349
Mailing Address - Country:US
Mailing Address - Phone:907-227-7991
Mailing Address - Fax:907-868-4768
Practice Address - Street 1:7101 SHOORESIN CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1349
Practice Address - Country:US
Practice Address - Phone:907-227-7991
Practice Address - Fax:907-868-4768
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK291839171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications