Provider Demographics
NPI:1952512238
Name:ZAJAC, PETER (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2917
Mailing Address - Street 2:PIKEVILLE MEDICAL CENTER INC.
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:
Practice Address - Street 1:184 S MAYO TRL
Practice Address - Street 2:PIKEVILLE MEDICAL CENTER INC.
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1518
Practice Address - Country:US
Practice Address - Phone:606-218-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008586-L207Q00000X
TN1873207Q00000X
KY03253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100099860Medicaid
KY7100099860Medicaid