Healthcare Provider Details

I. General information

NPI: 1093823718
Provider Name (Legal Business Name): DAVID A. PETERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-6749
US

IV. Provider business mailing address

3812 ACADEMY PARKWAY NORTH NE
ALBUQUERQUE NM
87109-4409
US

V. Phone/Fax

Practice location:
  • Phone: 505-938-7431
  • Fax: 505-814-6039
Mailing address:
  • Phone: 505-938-7431
  • Fax: 505-814-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number89-87
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: