Provider Demographics
NPI:1588783716
Name:PEREGO, ALAN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAY
Last Name:PEREGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 PLANTATION RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-5051
Mailing Address - Country:US
Mailing Address - Phone:225-767-8332
Mailing Address - Fax:
Practice Address - Street 1:4502 HIGHWAY 951
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748
Practice Address - Country:US
Practice Address - Phone:225-634-0341
Practice Address - Fax:225-634-4464
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0112399 00Medicaid
LA1918750Medicaid
LA5N735Medicare ID - Type Unspecified
LAF03426Medicare UPIN
LA1918750Medicaid