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NPI Code Detail

MEDICARE: PETER DONALD ALEXANDER

MEDICARE: PETER DONALD ALEXANDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramIL

General Provider Information

NPI Number : 1912795105
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER DONALD ALEXANDER
Provider Business Mailing Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-6710
Fax Number : 309-624-9887
Provider Business Practice Location Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-6710
Fax Number : 309-624-9887
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 01/12/2026

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Directions to “ PETER DONALD ALEXANDER ” Practice Location

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