Provider Demographics
NPI:1861136673
Name:PETERS, SIDNEY ANN
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-EMR
Mailing Address - Street 2:3551 ROGER BROOKE DRIVE, JBSA - FORT SAM HOUSTON
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:78234-4504
Mailing Address - Country:US
Mailing Address - Phone:210-916-4789
Mailing Address - Fax:210-916-6654
Practice Address - Street 1:SAN ANTONIO MILITARY MEDICAL CENTER, MCHE-EMR
Practice Address - Street 2:3551 ROGER BROOKE DRIVE, JBSA - FORT SAM HOUSTON
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4789
Practice Address - Fax:210-916-6654
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider