Provider Demographics
NPI:1427086370
Name:TAYLOR PETERS, SUSAN MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MICHELLE
Last Name:TAYLOR PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LAKEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5698
Mailing Address - Country:US
Mailing Address - Phone:415-961-6629
Mailing Address - Fax:
Practice Address - Street 1:3900 LAKEVILLE HIGHWAY
Practice Address - Street 2:OBSTETRICS AND GYNECOLOGY
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5698
Practice Address - Country:US
Practice Address - Phone:707-765-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA195408207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100088640Medicaid
KY000023036HOtherHUMANA- WOMENS SPECIALISTS
KY3704759000OtherPASSPORT ADVANTAGE- WOMENS SPECIALISTS
KY104115OtherSIHO- WOMEN'S SPECIALISTS
KY200524040OtherMEDICAID INDIANA- WOMEN'S SPECIALISTS
KY200524040OtherANTHEM INDIANA MEDICAID- WOMEN'S SPECIALISTS
KYP00869562OtherMEDICARE RAILROAD
KY000000613128OtherANTHEM- WOMENS SPECIALISTS
KY200524040OtherMANAGED HEALTH SERVICES- WOMEN'S SPECIALISTS
KY00533137OtherMEDICARE- WOMEN'S SPECIALISTS
KY7100088640Medicaid
KY200524040OtherMD WISE- WOMEN'S SPECIALISTS
KY200524040OtherHEALTHY INDIANA PLAN- WOMEN'S SPECIALISTS
KYP00869562OtherMEDICARE RAILROAD