Provider Demographics
NPI:1558560961
Name:BESS, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 OLD STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-3205
Mailing Address - Country:US
Mailing Address - Phone:636-296-4466
Mailing Address - Fax:636-296-6561
Practice Address - Street 1:1765 OLD STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3205
Practice Address - Country:US
Practice Address - Phone:636-296-4466
Practice Address - Fax:636-296-6561
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010003398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1558560961Medicaid