Provider Demographics
NPI:1417909847
Name:PETERS, TIMOTHY DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DOUGLAS
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 1:2510 AIRPARK DR
Mailing Address - Street 2:SUITE #305
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2449
Mailing Address - Country:US
Mailing Address - Phone:530-241-8822
Mailing Address - Fax:530-241-0746
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE #305
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2449
Practice Address - Country:US
Practice Address - Phone:530-241-8822
Practice Address - Fax:530-241-0746
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76391207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G763910Medicaid
CAE68281Medicare UPIN
CA00G763910Medicaid