Provider Demographics
NPI:1013004860
Name:PETERS, JOHN STEWART (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEWART
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 DOGWOOD ACRES
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9368
Mailing Address - Country:US
Mailing Address - Phone:406-299-0871
Mailing Address - Fax:
Practice Address - Street 1:2798 DOGWOOD ACRES
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9368
Practice Address - Country:US
Practice Address - Phone:406-299-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45315207N00000X, 207NS0135X
ALDO.3331207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD000Medicare UPIN