Provider Demographics
NPI:1992752950
Name:COMPTON, PETER H (PAC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:COMPTON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1042
Mailing Address - Country:US
Mailing Address - Phone:937-760-3481
Mailing Address - Fax:419-469-8887
Practice Address - Street 1:4235 SECOR RD
Practice Address - Street 2:BUILDING #1, UPPER LEVEL
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4231
Practice Address - Country:US
Practice Address - Phone:419-479-5424
Practice Address - Fax:419-479-5425
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOPA19154Medicare PIN
P62141Medicare UPIN
OHCOPA19153Medicare PIN