Provider Demographics
NPI:1669435343
Name:MORIN, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:MORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 N COTNER BLVD SUITE 205
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2344
Mailing Address - Country:US
Mailing Address - Phone:402-467-4661
Mailing Address - Fax:405-467-5006
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:SYE 205
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-467-4661
Practice Address - Fax:402-467-5006
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE18258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054632400Medicaid
NE080028227OtherRAILROAD MC ID
NE18258OtherNE STATE LICENSE
NE00258OtherBCBS PROVIDER ID
NE00258OtherBCBS PROVIDER ID
NE18258OtherNE STATE LICENSE
NEE28315Medicare UPIN