Provider Demographics
NPI:1740621549
Name:PETER ALAN RAO, M.D., PLLC
Entity type:Organization
Organization Name:PETER ALAN RAO, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-747-4900
Mailing Address - Street 1:5544 S LEWIS AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7105
Mailing Address - Country:US
Mailing Address - Phone:918-747-4900
Mailing Address - Fax:918-747-4903
Practice Address - Street 1:5544 S LEWIS AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7105
Practice Address - Country:US
Practice Address - Phone:918-747-4900
Practice Address - Fax:918-747-4903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24115261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health