Basic Information
| Provider Information | |||||||||
| NPI: | 1255699435 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | FAST | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE STE 1200 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886687 | ||||||||
| FaxNumber: | 9184886098 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 N MAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744014078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186842663 | ||||||||
| FaxNumber: | 9186816804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 29225 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 29225 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.