Provider Demographics
NPI:1861470445
Name:KINNEBREW, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:KINNEBREW
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 1:13596 HWY 231 431 N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-8617
Mailing Address - Country:US
Mailing Address - Phone:256-828-2094
Mailing Address - Fax:256-828-0526
Practice Address - Street 1:13596 HWY 231 431 N
Practice Address - Street 2:SUITE 2
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8642
Practice Address - Country:US
Practice Address - Phone:256-828-2094
Practice Address - Fax:256-828-0526
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL221852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009981810Medicaid
AL51045542OtherBCBS
AL009981810Medicaid
ALB09257Medicare UPIN