Provider Demographics
NPI:1376703330
Name:ENYEART, PETER JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAY
Last Name:ENYEART
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 1:400 E STATESVILLE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2588
Mailing Address - Country:US
Mailing Address - Phone:704-663-1992
Mailing Address - Fax:
Practice Address - Street 1:400 E STATESVILLE AVE STE 300
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2588
Practice Address - Country:US
Practice Address - Phone:704-663-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine