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General NPI Number Information
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NPI Number | 1194775429
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Entity Type | Individual
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Provider Name | MICHAEL D PETERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 3806 SAWTELL RD
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City | LITTLE RIVER
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State | SC
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Zip | 29566-7873
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Country | US
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Telephone | 843-663-9090
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Fax | 843-663-9091
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Provider Business Mailing Address
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Address Line | 1859 HICKORY LN
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City | LONGS
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State | SC
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Zip | 29568-6519
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Country | US
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Telephone | 843-222-1142
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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 | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 2013-01576
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | MD28577
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License Number State | SC
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