Provider Demographics
NPI:1992772974
Name:PETERS, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:31 S STANFIELD RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2374
Mailing Address - Country:US
Mailing Address - Phone:937-339-1518
Mailing Address - Fax:937-339-1538
Practice Address - Street 1:31 STANFIELD RD.
Practice Address - Street 2:SUITE 304
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2334
Practice Address - Country:US
Practice Address - Phone:937-339-1518
Practice Address - Fax:937-339-1538
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35053830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694315Medicaid
OH0694315Medicaid
OH0815342Medicare PIN