Provider Demographics
NPI:1336102227
Name:DEVEAUX, PETER GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GERARD
Last Name:DEVEAUX
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 1:216 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3519
Mailing Address - Country:US
Mailing Address - Phone:406-488-2278
Mailing Address - Fax:406-488-2523
Practice Address - Street 1:216 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3519
Practice Address - Country:US
Practice Address - Phone:406-488-2278
Practice Address - Fax:406-488-2523
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093519208600000X
WV29974208600000X
KY46444208C00000X
MT102083208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT830702218OtherMONTANA
KY7100250090Medicaid
KY50052210OtherPASSPORT
KY7100250090Medicaid