Provider Demographics
NPI:1366482994
Name:PETERS, DAN WT (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:WT
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5533
Mailing Address - Country:US
Mailing Address - Phone:850-385-2222
Mailing Address - Fax:850-385-1844
Practice Address - Street 1:1690 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5533
Practice Address - Country:US
Practice Address - Phone:850-385-2222
Practice Address - Fax:850-385-1844
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62076YMedicare ID - Type Unspecified
FLH32137Medicare UPIN