Healthcare Provider Details

I. General information

NPI: 1588071484
Provider Name (Legal Business Name): ELDON PETERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2014
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

IV. Provider business mailing address

1514 GLENWOOD AVE
RALEIGH NC
27608-2368
US

V. Phone/Fax

Practice location:
  • Phone: 919-829-0076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number656
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006596
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: