Provider Demographics
NPI:1023005832
Name:PETERS, MELISSA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LEIGH
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 5TH AVE S STE 110
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1700
Mailing Address - Country:US
Mailing Address - Phone:205-638-9587
Mailing Address - Fax:205-975-4623
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9587
Practice Address - Fax:205-975-4623
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.26029207P00000X, 208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-09841OtherBCBS
AL7647655OtherAETNA
AL515-24090OtherBCBS
AL102257Medicaid
AL1023005832OtherTRICARE SOUTH
AL009964455Medicaid
AL102257Medicaid