Healthcare Provider Details

I. General information

NPI: 1962484758
Provider Name (Legal Business Name): BRIAN J PEERLESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD SUITE C208
BLUE ASH OH
45242-6895
US

IV. Provider business mailing address

9403 KENWOOD RD SUITE C208
BLUE ASH OH
45242-6895
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-5532
  • Fax: 513-891-5323
Mailing address:
  • Phone: 513-891-5532
  • Fax: 513-891-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35082973 P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: