Provider Demographics
NPI:1912990870
Name:PETERS, EDWIN ERIC (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:ERIC
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:505
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-697-0082
Mailing Address - Fax:702-369-5827
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:888-350-2911
Practice Address - Fax:702-369-5827
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA72982208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H00771Medicare UPIN
NV103624Medicare UPIN
CAWA72982AMedicare PIN