MEDICARE: DR. STEPHEN ROBERT PETERS 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	207RC0000X	Cardiovascular Disease Physician	G83285	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ069702	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679545388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ROBERT PETERS M.D.

Provider Business Mailing Address
First Line	:	2 MEDICAL PLAZA DR
Second Line	:	SUITE #175
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-782-2146
Fax Number	:	916-782-4299

Provider Business Practice Location Address
First Line	:	2 MEDICAL PLAZA DR
Second Line	:	SUITE #175
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-3043
Country	:	US
Telephone Number	:	916-782-2146
Fax Number	:	916-782-4299

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/02/2014

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