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General NPI Number Information
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NPI Number | 1033351234
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Entity Type | Individual
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Provider Name | GREGORY MICHAEL PETERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 07/01/2013
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Provider Practice Location Address
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Address Line | 11 N LOCUST ST
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City | BUCKHANNON
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State | WV
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Zip | 26201-2231
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Country | US
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Telephone | 304-473-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 84 JARRETT DR
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City | BUCKHANNON
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State | WV
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Zip | 26201-8917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24383
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License Number State | WV
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