Provider Demographics
NPI:1811945280
Name:ST. PETERY, MARIAN LEIGH (DO)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:LEIGH
Last Name:ST. PETERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HARPERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35078-4701
Mailing Address - Country:US
Mailing Address - Phone:205-672-1002
Mailing Address - Fax:205-672-1009
Practice Address - Street 1:71 JACKSON ST
Practice Address - Street 2:
Practice Address - City:HARPERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35078-4701
Practice Address - Country:US
Practice Address - Phone:205-672-1002
Practice Address - Fax:205-672-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-27516OtherBCBS#
AL515-28701OtherBCBS#
ALH84144Medicare UPIN