Provider Demographics
NPI:1184663833
Name:PETERS, JANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1417 S. CLIFF AVE.
Practice Address - Street 2:STE 401
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1064
Practice Address - Country:US
Practice Address - Phone:605-322-8920
Practice Address - Fax:605-322-8919
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI07-00188OtherPHP
MI07-70188OtherPHP FAMILYCARE
MI1603306242OtherBCBS/BCN
MI4679610Medicaid
SD7223OtherDAKOTACARE
SD6201560Medicaid
SD6201560Medicaid
MI07-70188OtherPHP FAMILYCARE
MI07-00188OtherPHP