Individual
EDWARD A PELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 CENTENNIAL DR, CHADRON, NE 69337-9400
(308) 432-4441
(308) 432-2130
Mailing address
825 CENTENNIAL DR, PO BOX 431, CHADRON, NE 69337-9400
(308) 432-4441
(308) 432-2130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18841
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00081
BLUE SHIELD PROVIDER NUMB
NE
01
—
18841
STATE LICENSE NUMBER
NE
Enumeration date
11/21/2005
Last updated
01/26/2011
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