Healthcare Provider Details

I. General information

NPI: 1417927229
Provider Name (Legal Business Name): LAWRENCE H PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE SUITE 404
LOUISVILLE KY
40215-1190
US

IV. Provider business mailing address

PO BOX 30563
BELFAST ME
04915-2057
US

V. Phone/Fax

Practice location:
  • Phone: 502-363-4156
  • Fax: 502-363-4158
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number31716
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: