Provider Demographics
NPI:1710129770
Name:KOHLER, PETER OGDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:OGDEN
Last Name:KOHLER
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 1:2907 E JOYCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5011
Mailing Address - Country:US
Mailing Address - Phone:479-684-5124
Mailing Address - Fax:479-521-8723
Practice Address - Street 1:2907 E JOYCE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5011
Practice Address - Country:US
Practice Address - Phone:479-684-5124
Practice Address - Fax:479-521-8723
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine