Healthcare Provider Details

I. General information

NPI: 1881851871
Provider Name (Legal Business Name): WILLIAM MICHAEL PELTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DOCTOR'S PARK
CAPE GIRARDEAU MO
63703
US

IV. Provider business mailing address

70 DOCTOR'S PARK
CAPE GIRARDEAU MO
63703
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-6071
  • Fax: 573-334-4739
Mailing address:
  • Phone: 573-334-6071
  • Fax: 573-334-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2009029455
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: