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General NPI Number Information
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NPI Number | 1407913270
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Entity Type | Individual
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Provider Name | JACQUELINE ANN PETERS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 1233 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601
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Country | US
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Telephone | 307-577-7201
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Fax |
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Provider Business Mailing Address
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Address Line | 742 S DAVID ST
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City | CASPER
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State | WY
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Zip | 82601-3137
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Country | US
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Telephone | 307-234-9657
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Fax | 307-234-0306
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036103426
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 42785-020
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11648A
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License Number State | WY
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