Basic Information
Provider Information
NPI: 1417943655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEGG
FirstName: WILLIAM
MiddleName: MCKEAN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 277219
Address2:  
City: ATLANTA
State: GA
PostalCode: 303847219
CountryCode: US
TelephoneNumber: 8009191190
FaxNumber: 7067372272
Practice Location
Address1: 6500 66TH ST
Address2:  
City: PINELLAS PARK
State: FL
PostalCode: 337815030
CountryCode: US
TelephoneNumber: 7273471286
FaxNumber: 7278281460
Other Information
ProviderEnumerationDate: 09/22/2005
LastUpdateDate: 08/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME 44943FLY Allopathic & Osteopathic PhysiciansAnesthesiology 
207LP2900XME 44943FLN Allopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine

No ID Information.


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