Provider Demographics
NPI:1568601540
Name:PETER DSA, MD, PC
Entity Type:Organization
Organization Name:PETER DSA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-362-6357
Mailing Address - Street 1:203 MEDICAL PARK OFC PARK
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2213
Mailing Address - Country:US
Mailing Address - Phone:256-362-6357
Mailing Address - Fax:256-362-5818
Practice Address - Street 1:203 MEDICAL PARK OFC PARK
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2213
Practice Address - Country:US
Practice Address - Phone:256-362-6357
Practice Address - Fax:256-362-5818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25482207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty