Provider Demographics
NPI:1013987965
Name:MCNALLY, PETER R (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:ATTN CREDENTIALS OFFICE
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:GI CLINIC
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-526-7453
Practice Address - Fax:719-526-7007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2022-04-14
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Provider Licenses
StateLicense IDTaxonomies
CO31935207RG0100X
MOR3E28207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88234347Medicaid
DAD000Medicare UPIN
F72840Medicare ID - Type Unspecified