MEDICARE: JOHN CHRISTOPHER 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	207Q00000X	Family Medicine Physician	35053830	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1992772974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CHRISTOPHER PETERS MD

Provider Business Mailing Address
First Line	:	31 S STANFIELD RD
Second Line	:	SUITE 304
City	:	TROY
State	:	OH
Zip	:	45373-2374
Country	:	US
Telephone Number	:	937-339-1518
Fax Number	:	937-339-1538

Provider Business Practice Location Address
First Line	:	31 STANFIELD RD.
Second Line	:	SUITE 304
City	:	TROY
State	:	OH
Zip	:	45373-2334
Country	:	US
Telephone Number	:	937-339-1518
Fax Number	:	937-339-1538

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	10/27/2020

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