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General NPI Number Information
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NPI Number | 1083734123
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Entity Type | Individual
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Provider Name | MHROOS FAIK BARAK PETERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 1213 N MAIN ST
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City | BEAVER DAM
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State | KY
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Zip | 42320-8955
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Country | US
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Telephone | 270-274-4771
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Fax | 270-274-4884
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-302-6565
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 0101267619
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101267619
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 249349
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 59935
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License Number State | KY
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