Provider Demographics
NPI:1861711723
Name:PETERS, TODD (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E 6TH
Mailing Address - Street 2:STE 2C
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156
Mailing Address - Country:US
Mailing Address - Phone:620-402-6699
Mailing Address - Fax:620-307-2993
Practice Address - Street 1:1230 E 6TH AVE STE 2C
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3145
Practice Address - Country:US
Practice Address - Phone:620-402-6699
Practice Address - Fax:620-402-6061
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0435662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics