Provider Demographics
NPI:1245310226
Name:STEGE, PETER (DOM)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:STEGE
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HOT SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3441
Mailing Address - Country:US
Mailing Address - Phone:505-454-0003
Mailing Address - Fax:505-454-0003
Practice Address - Street 1:2002 HOT SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3441
Practice Address - Country:US
Practice Address - Phone:505-454-0003
Practice Address - Fax:505-454-0003
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR42DOtherBCBS OF NM