Provider Demographics
NPI:1144312778
Name:JUST, PETER W (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:JUST
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:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:50 UNION ST, SUITE 3100
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-667-6434
Practice Address - Fax:207-667-3040
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012720207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024579OtherANTHEM
ME218270099Medicaid
ME010501181OtherTAX ID #
MEC82108Medicare UPIN
ME010501181OtherTAX ID #
MM245701Medicare PIN
MEMM2457Medicare PIN