Provider Demographics
NPI:1073840070
Name:RICHARD A PETERS, M.D. PC
Entity Type:Organization
Organization Name:RICHARD A PETERS, M.D. PC
Other - Org Name:RICHARD A PETERS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-212-4970
Mailing Address - Street 1:3300 PROVIDENCE DR
Mailing Address - Street 2:SUITE 04
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4671
Mailing Address - Country:US
Mailing Address - Phone:907-212-4970
Mailing Address - Fax:907-212-4912
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:SUITE 04
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4671
Practice Address - Country:US
Practice Address - Phone:907-212-4970
Practice Address - Fax:907-212-4912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD A PETERS, M.D.PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD3188208600000X, 2086S0102X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3188Medicaid
K151720Medicare PIN
AKMD3188Medicaid