Provider Demographics
NPI:1750384632
Name:MUIR, PETER J (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:MUIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9285
Mailing Address - Country:US
Mailing Address - Phone:937-399-7777
Mailing Address - Fax:937-399-6794
Practice Address - Street 1:3250 MIDDLE URBANA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9285
Practice Address - Country:US
Practice Address - Phone:937-399-7777
Practice Address - Fax:937-399-6794
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-09-26
Deactivation Date:2019-07-31
Deactivation Code:
Reactivation Date:2019-09-26
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2843-M207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080068219OtherRR MEDICARE
OH311202780006OtherCIGNA
OH4293529OtherAETNA
OHOH0031308OtherTRICARE/CHAMPUS
OH0101872OtherUNITED HEALTH CARE
OH0915139Medicaid
OH000000013715OtherANTHEM
OH000000013715OtherANTHEM