Healthcare Provider Details

I. General information

NPI: 1518142124
Provider Name (Legal Business Name): GREGORY THOMAS PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLEVUE MEDICAL CENTER DR
BELLEVUE NE
68123-1591
US

IV. Provider business mailing address

17030 LAKESIDE HILLS PLZ SUITE 200
OMAHA NE
68130-2396
US

V. Phone/Fax

Practice location:
  • Phone: 402-361-5225
  • Fax:
Mailing address:
  • Phone: 402-361-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA106752
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number43107
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28761
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: