Healthcare Provider Details

I. General information

NPI: 1386685451
Provider Name (Legal Business Name): CALVIN RONALD PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 442
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 442
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-1436
  • Fax: 407-898-6330
Mailing address:
  • Phone: 407-898-1436
  • Fax: 407-898-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME0023807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: