Provider Demographics
NPI:1710958483
Name:RAO, PETER ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:RAO
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 1:5544 S LEWIS AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7105
Mailing Address - Country:US
Mailing Address - Phone:918-747-4900
Mailing Address - Fax:918-747-4903
Practice Address - Street 1:5544 S LEWIS AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7105
Practice Address - Country:US
Practice Address - Phone:918-747-4900
Practice Address - Fax:918-747-4903
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK241152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK248507810Medicare ID - Type Unspecified
OKF35400Medicare UPIN
4673890OtherAETNA BEHAVIORAL HEALTH