MEDICARE: DR. THOMAS 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
1	207R00000X	Internal Medicine Physician	9056	NV

General Provider Information

NPI Number	:	1659432250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS PETERS MD

Provider Business Mailing Address
First Line	:	500 E WINDMILL LN
Second Line	:	STE 125
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1845
Country	:	US
Telephone Number	:	702-263-4795
Fax Number	:	702-263-4804

Provider Business Practice Location Address
First Line	:	105 N PECOS RD
Second Line	:	STE113
City	:	HENDERSON
State	:	NV
Zip	:	89074-1995
Country	:	US
Telephone Number	:	702-263-4795
Fax Number	:	702-263-4804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	09/28/2021

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