Provider Demographics
NPI:1639281595
Name:SELIKOFF, PETER STROM (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:STROM
Last Name:SELIKOFF
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 1:6610 CURRY HWY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-5664
Mailing Address - Country:US
Mailing Address - Phone:205-295-2020
Mailing Address - Fax:205-295-2099
Practice Address - Street 1:6610 CURRY HWY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-5664
Practice Address - Country:US
Practice Address - Phone:205-295-2020
Practice Address - Fax:205-295-2099
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5933208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5933OtherLICENSE
AL000005597Medicaid
ALC76504Medicare UPIN
510I340019Medicare PIN