Provider Demographics
NPI:1154499945
Name:PETERS, JOHN WARREN (DR MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:PETERS
Suffix:
Gender:M
Credentials:DR MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6062 WENRICH DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3717
Mailing Address - Country:US
Mailing Address - Phone:619-286-2244
Mailing Address - Fax:619-688-6480
Practice Address - Street 1:7575 METROPOLITAN DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4421
Practice Address - Country:US
Practice Address - Phone:619-688-6470
Practice Address - Fax:619-688-6480
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC23746207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC237460Medicaid
H79639Medicare UPIN