Provider Demographics
NPI:1376667444
Name:FREDERICK J PEET DPM PC
Entity Type:Organization
Organization Name:FREDERICK J PEET DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:636-239-0202
Mailing Address - Street 1:1201 JEFFERSON ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4451
Mailing Address - Country:US
Mailing Address - Phone:636-239-0202
Mailing Address - Fax:636-239-0217
Practice Address - Street 1:1201 JEFFERSON ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4454
Practice Address - Country:US
Practice Address - Phone:636-239-0202
Practice Address - Fax:636-239-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000548213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4670200OtherAETNA
MO302302401Medicaid
MO9774OtherBCBS OF MISSOURI
MO480023932OtherRAILROAD MEDICARE
MO107216OtherHEALTHLINK
MO18509OtherHEALTHCARE USA
MO2700040OtherUNITED HEALTHCARE
MO9774OtherBCBS OF MISSOURI
MOT42896Medicare UPIN
MO4670200OtherAETNA