Provider Demographics
NPI:1588021174
Name:SEMRAD, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SEMRAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W ALBANY ST
Mailing Address - Street 2:APT 935
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1486
Mailing Address - Country:US
Mailing Address - Phone:414-881-0090
Mailing Address - Fax:
Practice Address - Street 1:3330 N MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-1211
Practice Address - Country:US
Practice Address - Phone:414-881-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program