Basic Information
Provider Information | |||||||||
NPI: | 1669402137 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PEER | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | W | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3651 COLLEGE BLVD STE 100A | ||||||||
Address2: |   | ||||||||
City: | LEAWOOD | ||||||||
State: | KS | ||||||||
PostalCode: | 662111910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133197500 | ||||||||
FaxNumber: | 9133197691 | ||||||||
Practice Location | |||||||||
Address1: | 3651 COLLEGE BLVD STE 100A | ||||||||
Address2: |   | ||||||||
City: | LEAWOOD | ||||||||
State: | KS | ||||||||
PostalCode: | 662111910 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9133197500 | ||||||||
FaxNumber: | 9133197691 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 06/11/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/11/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 0420011001 | VT | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207X00000X | 04-31227 | KS | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 00069377 | 01 | VT | BLUE SHIELD | OTHER | 1012828 | 05 | VT |   | MEDICAID | P00332392 | 01 | VT | RAILROAD MEDICARE | OTHER | 390541 | 01 | VT | MVP | OTHER | 0572880002 | 01 | VT | DME | OTHER |