Provider Demographics
NPI:1376572784
Name:PETERS, ANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:9033 WILSHIRE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1847
Practice Address - Country:US
Practice Address - Phone:310-272-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53070207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530700OtherBLUE SHIELD
CA00G530700Medicaid
CA1356390009OtherGROUP NPI
CAW11675OtherGROUP MEDICARE PIN
CA06E2774OtherGROUP CHAMPUS
CAGR0016910OtherGROUP MEDICAID PIN
CA1902846306OtherGROUP NPI
CAZZZ50018ZOtherGROUP BLUE SHIELD
CA460002952OtherRAILROAD MEDICARE
CACE1617OtherGROUP RAILROAD MEDICARE
CAGR0100430OtherGROUP MEDICAL
CAW18762OtherGROUP MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CA00G530700Medicaid