Provider Demographics
NPI:1144328022
Name:MCLEAY, PETER D (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:MCLEAY
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 1:8552 CASS ST
Mailing Address - Street 2:#308
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3570
Mailing Address - Country:US
Mailing Address - Phone:402-991-5300
Mailing Address - Fax:402-991-5407
Practice Address - Street 1:8552 CASS ST
Practice Address - Street 2:#308
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3570
Practice Address - Country:US
Practice Address - Phone:402-991-5300
Practice Address - Fax:402-991-5407
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18014207RC0000X
IA30071207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1937219Medicaid
110145179OtherRR MEDICARE
NE31944OtherBC
IA59814OtherBC
2500216OtherUHC
PA434127OtherBC
PA434127OtherBC
IAI5157Medicare PIN
F23638Medicare UPIN