MEDICARE: SCOTT PETERS DPM CWS LTD

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36003015P	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CK2777	OTHER	OH	MEDICARE RAILROAD

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	:	1427093160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT PETERS DPM CWS LTD

Provider Business Mailing Address
First Line	:	730 SOM CENTER RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2362
Country	:	US
Telephone Number	:	440-995-1111
Fax Number	:	440-995-1234

Provider Business Practice Location Address
First Line	:	730 SOM CENTER RD
Second Line	:
City	:	MAYFIELD VILLAGE
State	:	OH
Zip	:	44143-2350
Country	:	US
Telephone Number	:	440-995-1111
Fax Number	:	440-995-1234

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SCOTT G PETERS
Credential	:	DPM, CWS
Telephone Number	:	440-995-1111

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	05/30/2008

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Directions to “SCOTT PETERS DPM CWS LTD ” Practice Location

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