Healthcare Provider Details

I. General information

NPI: 1508964917
Provider Name (Legal Business Name): RICHARD A PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PROVIDENCE DR SUITE 04
ANCHORAGE AK
99508-4616
US

IV. Provider business mailing address

3300 PROVIDENCE DR SUITE 04
ANCHORAGE AK
99508-4616
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-4970
  • Fax: 907-212-4912
Mailing address:
  • Phone: 907-212-4970
  • Fax: 907-212-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD3188
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD3188
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD3188
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD3188
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: