Provider Demographics
NPI:1053493882
Name:PETERS, ROBERT M JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:440 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8695
Mailing Address - Country:US
Mailing Address - Phone:502-624-9503
Mailing Address - Fax:502-624-9747
Practice Address - Street 1:851 IRELAND LOOP, CES, IACH
Practice Address - Street 2:
Practice Address - City:FT. KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121
Practice Address - Country:US
Practice Address - Phone:502-624-9503
Practice Address - Fax:502-624-9747
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant