Provider Demographics
NPI:1861735482
Name:PETERS, LORI ANN
Entity type:Individual
Prefix:
First Name:LORI
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 1:10 S 3RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5346
Mailing Address - Country:US
Mailing Address - Phone:918-421-6795
Mailing Address - Fax:918-421-6791
Practice Address - Street 1:10 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5346
Practice Address - Country:US
Practice Address - Phone:918-382-3178
Practice Address - Fax:918-382-6789
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5612207Q00000X
OKFP4721747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine