Provider Demographics
NPI:1063401685
Name:PASHLEY, PETER R (DO)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:R
Last Name:PASHLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-1680
Mailing Address - Country:US
Mailing Address - Phone:810-765-8750
Mailing Address - Fax:810-765-4326
Practice Address - Street 1:130 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-1680
Practice Address - Country:US
Practice Address - Phone:810-765-8750
Practice Address - Fax:810-765-4326
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013427207R00000X
MI1154447464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114444391Medicaid
1157400904OtherBCBS
MIN95380001Medicare PIN
1157400904OtherBCBS
MI114444391Medicaid