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NPI Code Detail

MEDICARE: MR. ROBERT M PETERS JR. PA-C

MEDICARE:  MR. ROBERT M PETERS JR. PA-C
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
1363A00000XPhysician AssistantPA499KY

General Provider Information

NPI Number : 1053493882
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT M PETERS JR. PA-C
Provider Business Mailing Address
First Line : 440 CEDAR HILL DR
Second Line :
City : ELIZABETHTOWN
State : KY
Zip : 42701-8695
Country : US
Telephone Number : 502-624-9503
Fax Number : 502-624-9747
Provider Business Practice Location Address
First Line : 851 IRELAND LOOP, CES, IACH
Second Line :
City : FT. KNOX
State : KY
Zip : 40121
Country : US
Telephone Number : 502-624-9503
Fax Number : 502-624-9747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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Directions to “ MR. ROBERT M PETERS JR. PA-C” Practice Location

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