Individual
PETER P JIANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 SAINT FRANCIS DR, SPECIALTY CLINIC, CAPE GIRARDEAU, MO 63703-5049
(573) 331-5932
(573) 331-5931
Mailing address
3170 COUNTY ROAD 635, CAPE GIRARDEAU, MO 63701-8656
(573) 334-6202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005023732
MO
207RI0200X
Infectious Disease Physician
Primary
2005023732
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199929
BLUE SHIELD/BLUE CHOICE
MO
05
—
200307908
—
MO
01
—
718095
HEALTHLINK
MO
Enumeration date
05/08/2006
Last updated
12/03/2013
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