Provider Demographics
NPI:1306827894
Name:LE, PETER QUOC (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:QUOC
Last Name:LE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-2629
Mailing Address - Country:US
Mailing Address - Phone:405-943-9820
Mailing Address - Fax:405-947-6908
Practice Address - Street 1:2201 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-2629
Practice Address - Country:US
Practice Address - Phone:405-943-9820
Practice Address - Fax:405-947-6908
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPOD209213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200241830AMedicaid
OK731624991OtherCIGNA GOVERNMENT
OK200241830AMedicaid
OK4847060001Medicare NSC
OK731624991Medicare PIN
OK$$$$$$$$$OtherCIGNA GOVERNMENT
OKU81595Medicare UPIN