Provider Demographics
NPI:1669431748
Name:PEER, PETER M (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:PEER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:MCKINLEY
Other - Last Name:PEER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1400 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3306
Mailing Address - Country:US
Mailing Address - Phone:989-992-2351
Mailing Address - Fax:573-755-0276
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:989-992-2351
Practice Address - Fax:573-755-0276
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010148412085R0202X
KS05278272085R0202X
KS05272872085U0001X, 2085D0003X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
3150910275OtherBXBS MI
MI4754438Medicaid
MI1669431748Medicaid
MI4754438Medicaid
MI4754438Medicaid