Provider Demographics
NPI:1821048091
Name:KILLIAN, PETER JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:KILLIAN
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 1:1157 N SUMMERBROOK AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8759
Mailing Address - Country:US
Mailing Address - Phone:208-593-4484
Mailing Address - Fax:208-593-4491
Practice Address - Street 1:1157 N SUMMERBROOK AVE STE 120
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8759
Practice Address - Country:US
Practice Address - Phone:208-593-4484
Practice Address - Fax:208-593-4491
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70221207Y00000X
WA60132112207Y00000X
IDM-11713207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology