Provider Demographics
NPI:1801991013
Name:ALLYN, PETER GEORGE (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:GEORGE
Last Name:ALLYN
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 1:1180 COLLEGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5868
Mailing Address - Country:US
Mailing Address - Phone:307-352-8471
Mailing Address - Fax:307-352-8477
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:307-352-8471
Practice Address - Fax:307-352-8477
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3681A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107013400Medicaid
D98396Medicare UPIN
WY107013400Medicaid
4110248Medicare ID - Type Unspecified