Provider Demographics
NPI:1568527190
Name:PLASSE, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:PLASSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:PLASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316
Mailing Address - Country:US
Mailing Address - Phone:710-477-6111
Mailing Address - Fax:
Practice Address - Street 1:3073 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-7101
Practice Address - Country:US
Practice Address - Phone:603-356-5461
Practice Address - Fax:844-657-9592
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035171207P00000X
NH18041207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB95344Medicare UPIN