MEDICARE: DR. PETER W SOMERS PH.D. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036108617	IL

General Provider Information

NPI Number	:	1033182092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER W SOMERS PH.D. M.D.

Provider Business Mailing Address
First Line	:	6709 HWY W
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-8785
Country	:	US
Telephone Number	:	573-840-4091
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 SOUTH PRAIRIE STREET
Second Line	:
City	:	BLOOMFIELD
State	:	MO
Zip	:	63825
Country	:	US
Telephone Number	:	573-568-3838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/30/2013

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