Provider Demographics
NPI:1386685451
Name:PETERS, CALVIN RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:RONALD
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 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 442
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-898-1436
Mailing Address - Fax:407-898-6330
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 442
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-898-1436
Practice Address - Fax:407-898-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00238072086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2701930OtherCIGNA
FL11596OtherFL HOSP HEALTHCARE SYSTEM
2001245OtherAETNA HMO QPDS
182080453061OtherHUMANA
4008522OtherAETNA PPO PDS
FL47322OtherBCBS OF FL
2001245OtherAETNA HMO QPDS
47322ZMedicare ID - Type Unspecified