Provider Demographics
NPI:1326017443
Name:PETERS, BRUCE WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
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 1:54 BEY LEA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2891
Mailing Address - Country:US
Mailing Address - Phone:732-281-0100
Mailing Address - Fax:732-281-0400
Practice Address - Street 1:54 BEY LEA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2891
Practice Address - Country:US
Practice Address - Phone:732-281-0100
Practice Address - Fax:732-281-0400
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06567300207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ037986Medicare ID - Type Unspecified
NJE92668Medicare UPIN