Provider Demographics
NPI:1710098181
Name:HINCKLE, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:HINCKLE
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 1:600 NE AVALON PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9258
Mailing Address - Country:US
Mailing Address - Phone:541-745-5053
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:600 NE AVALON PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-9258
Practice Address - Country:US
Practice Address - Phone:541-745-5053
Practice Address - Fax:503-391-7422
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057443Medicaid
OR057443Medicaid
ORA35687Medicare UPIN