MEDICARE: MR. ALAN WAYNE PETERS

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	332B00000X	Durable Medical Equipment & Medical Supplies	7548443	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78628	OTHER	MN	HEALTH PARTNERS
2	6513452318	OTHER	KY	HUMANA GOLD
3	137R7PA	OTHER	MN	BLUE CROSS & BLUE SHIELD
4	6513452318	OTHER	GA	UNITED HEALTH CARE INS
5	82-8229	OTHER	TX	MEDICA CHOICE
6	600708	OTHER	MN	MAYO MANAGMENT SERVICES
7	6513452318	OTHER	WI	WAUSAU INSURANCE COMPANY
8	7121523	OTHER	MN	PREFERRED ONE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	7683462	OTHER	TX	AETNA
11	181341	OTHER	MN	UCARE OF MN
12	HEALTH PARTNERS	OTHER	MN	INSURANCE COMPANY

General Provider Information

NPI Number	:	1982612321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN WAYNE PETERS

Provider Business Mailing Address
First Line	:	108 S LAKESHORE DR
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1641
Country	:	US
Telephone Number	:	651-345-2318
Fax Number	:	651-345-3310

Provider Business Practice Location Address
First Line	:	108 S LAKESHORE DR
Second Line	:
City	:	LAKE CITY
State	:	MN
Zip	:	55041-1641
Country	:	US
Telephone Number	:	651-345-2318
Fax Number	:	651-345-3310

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/09/2007

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Directions to “ MR. ALAN WAYNE PETERS ” Practice Location

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