Provider Demographics
NPI:1588774830
Name:PINTO, PETER W (CRNA)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:PINTO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:W
Other - Last Name:PINTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39568-1684
Mailing Address - Country:US
Mailing Address - Phone:228-762-9080
Mailing Address - Fax:228-762-0065
Practice Address - Street 1:3882 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5803
Practice Address - Country:US
Practice Address - Phone:228-872-6629
Practice Address - Fax:228-762-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR854706367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS430064343OtherMEDICARE RAILROAD
MS587210340COtherAHS STATE
MS0122707Medicaid
MS587210340COtherBLUE CROSS
009994065OtherALACAID
MS430064343OtherMEDICARE RAILROAD