Provider Demographics
NPI:1376531103
Name:PETERS, JOHN T (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2401 MANATEE AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-4933
Mailing Address - Country:US
Mailing Address - Phone:941-744-1336
Mailing Address - Fax:941-746-3846
Practice Address - Street 1:2401 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-4933
Practice Address - Country:US
Practice Address - Phone:941-744-1336
Practice Address - Fax:941-746-3846
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2018-02-27
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Provider Licenses
StateLicense IDTaxonomies
FLOS7555207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256226000Medicaid
FLG42550Medicare UPIN
FL256226000Medicaid