Provider Demographics
NPI:1841264769
Name:MCIVER, PETER K (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
Last Name:MCIVER
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 1:416 MONTROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4020
Mailing Address - Country:US
Mailing Address - Phone:850-501-0200
Mailing Address - Fax:
Practice Address - Street 1:416 MONTROSE BLVD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4020
Practice Address - Country:US
Practice Address - Phone:850-501-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44532207L00000X
VA0101230201207L00000X
GA024024207L00000X
IDM6915207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D46085Medicare UPIN