Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 2261 | WV |
NPI | 1164608121 |
---|---|
Provider Name | Dr. Peter J Alasky |
First Address | Bridgeport, WV 26330-9010 |
Second Address | Bridgeport, WV 26330-9010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 13/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002516572 | BLUE CROSS BLUE SHIELD (01) | WV |
3810019085 | MEDICAID (01) | WV |
4299681 | MEDICARE PTAN (01) | WV |
9567452 | AETNA (01) | WV |