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General NPI Number Information
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NPI Number | 1992884894
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Entity Type | Organization
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Legal Business Name | MICHAEL L PEASTER M D P C
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 500 E 5TH ST
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3909
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Country | US
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Telephone | 918-338-3800
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Fax | 918-336-1505
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Provider Business Mailing Address
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Address Line | 500 E 5TH ST
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City | BARTLESVILLE
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State | OK
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Zip | 74003-3909
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Country | US
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Telephone | 918-338-3800
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Fax | 918-336-1505
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL LEON PEASTER
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Credential | M.D.
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Telephone | 918-338-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 23383
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License Number State | OK
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