Provider Demographics
NPI:1164841557
Name:PETERS, COY (DO)
Entity Type:Individual
Prefix:
First Name:COY
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E KENOSHA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2098
Mailing Address - Country:US
Mailing Address - Phone:918-615-6941
Mailing Address - Fax:918-615-6942
Practice Address - Street 1:1801 E KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2098
Practice Address - Country:US
Practice Address - Phone:918-615-6941
Practice Address - Fax:918-615-6942
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine