Healthcare Provider Details

I. General information

NPI: 1568461747
Provider Name (Legal Business Name): ANTHONY G PETERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

IV. Provider business mailing address

1101 9TH ST SE
SIOUX CENTER IA
51250-2501
US

V. Phone/Fax

Practice location:
  • Phone: 712-722-2609
  • Fax: 712-722-8426
Mailing address:
  • Phone: 712-722-2609
  • Fax: 712-722-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0484
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number002094
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: