Provider Demographics
NPI:1104857598
Name:PETERS, WALTER J (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 ALHAMBRA AVE
Mailing Address - Street 2:#419
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6105
Mailing Address - Country:US
Mailing Address - Phone:925-930-3110
Mailing Address - Fax:925-229-2937
Practice Address - Street 1:233 CHRISTIE DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-5713
Practice Address - Country:US
Practice Address - Phone:925-930-3110
Practice Address - Fax:925-229-2937
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A504760Medicaid
CA00A504761OtherBLUE SHIELD
CAH047OtherCITY/ COUNTY SAN FRAN.
CA00A504760OtherBLUE SHIELD
CA00A504761Medicaid
CA00A504760Medicare ID - Type Unspecified
CA110117206Medicare ID - Type UnspecifiedRAIILROAD MEDICARE
CA00A504760Medicaid
CA00A504761OtherBLUE SHIELD