MEDICARE: LAWRENCE H PETERS MD

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	208VP0000X	Pain Medicine Physician	31716	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417927229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE H PETERS MD

Provider Business Mailing Address
First Line	:	PO BOX 30563
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2057
Country	:	US
Telephone Number	:	888-488-8289
Fax Number	:	502-919-9780

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:	SUITE 404
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-1190
Country	:	US
Telephone Number	:	502-363-4156
Fax Number	:	502-363-4158

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/16/2022

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