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General NPI Number Information
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NPI Number | 1306925565
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Entity Type | Organization
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Legal Business Name | RAY E PETERS D.O.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2210 BARRON RD SUITE 110
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-778-9598
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Fax | 573-778-9581
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Provider Business Mailing Address
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Address Line | 2210 BARRON RD SUITE 110
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-1908
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Country | US
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Telephone | 573-778-9598
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Fax | 573-778-9581
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAY E PETERS
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Credential | D.O.
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Telephone | 573-778-9598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R2C32
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License Number State | MO
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