Provider Demographics
NPI:1417252685
Name:PETERS, ANN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN J
Middle Name:
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 1:2377 GOLD MEADOW WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-631-1536
Mailing Address - Fax:
Practice Address - Street 1:2377 GOLD MEADOW WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4405
Practice Address - Country:US
Practice Address - Phone:916-631-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68861207QA0505X
NY243012-1207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine