Provider Demographics
NPI:1669447314
Name:DANIS, PETER G (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:DANIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12680 OLIVE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6322
Mailing Address - Country:US
Mailing Address - Phone:314-251-8889
Mailing Address - Fax:
Practice Address - Street 1:12680 OLIVE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6322
Practice Address - Country:US
Practice Address - Phone:314-251-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4C19207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1669447314Medicaid
MO080192174OtherRAILROAD MEDICARE
MO967265280Medicare PIN
MO1669447314Medicaid