Provider Demographics
NPI:1033182092
Name:SOMERS, PETER W (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:SOMERS
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 HWY W
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8785
Mailing Address - Country:US
Mailing Address - Phone:573-840-4091
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH PRAIRIE STREET
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:MO
Practice Address - Zip Code:63825
Practice Address - Country:US
Practice Address - Phone:573-568-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL104366Medicare UPIN