Provider Demographics
NPI:1427022243
Name:PETERS, ROBERT III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:PETERS
Suffix:III
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 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-5555
Mailing Address - Fax:570-622-2160
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-5555
Practice Address - Fax:570-622-2160
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022759E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001178676Medicaid
PA461081DX8Medicare ID - Type Unspecified
PA001178676Medicaid