Provider Demographics
NPI:1831115955
Name:OSTERBAUER, PETER J (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:OSTERBAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 770165
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-0165
Mailing Address - Country:US
Mailing Address - Phone:907-864-0022
Mailing Address - Fax:877-725-7371
Practice Address - Street 1:10928 EAGLE RIVER RD STE 129
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8078
Practice Address - Country:US
Practice Address - Phone:907-531-1840
Practice Address - Fax:907-531-1835
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS62712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1235310954OtherMEDICARE - GROUP AFFILIATION