Provider Demographics
NPI:1427002757
Name:PETERS, SCOTT G (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:PETERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-995-1111
Mailing Address - Fax:440-995-1234
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:SUITE 350
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-995-1111
Practice Address - Fax:440-995-1234
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003015P213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH480029293OtherMEDICARE RAILROAD
OH2040884Medicaid
OH2040884Medicaid
OH9326031Medicare PIN
OHU64271Medicare UPIN
OH0833285Medicare PIN