Healthcare Provider Details

I. General information

NPI: 1184800419
Provider Name (Legal Business Name): JAMES R PETERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W WATER ST SUITE 2
HANCOCK MI
49930-1950
US

IV. Provider business mailing address

920 W WATER ST SUITE 2
HANCOCK MI
49930-1950
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-2420
  • Fax:
Mailing address:
  • Phone: 906-483-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: