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NPI Code Detail

MEDICARE: DR. JAMES GLENN PETERS MD

MEDICARE: DR. JAMES GLENN PETERS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician08788MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114912680
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES GLENN PETERS MD
Provider Business Mailing Address
First Line : 8613 MS HIGHWAY 12
Second Line :
City : ACKERMAN
State : MS
Zip : 39735-8917
Country : US
Telephone Number : 662-285-9460
Fax Number : 662-285-9324
Provider Business Practice Location Address
First Line : 14724 HIGHWAY 15 N
Second Line :
City : LOUISVILLE
State : MS
Zip : 39339-6318
Country : US
Telephone Number : 662-773-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 03/10/2020

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