Provider Demographics
NPI:1437357431
Name:JOSEPH PETERS, M.D.
Entity Type:Organization
Organization Name:JOSEPH PETERS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-689-5232
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:COUNCE
Mailing Address - State:TN
Mailing Address - Zip Code:38326-0304
Mailing Address - Country:US
Mailing Address - Phone:731-689-5232
Mailing Address - Fax:731-689-3007
Practice Address - Street 1:8917 HIGHWAY 57
Practice Address - Street 2:
Practice Address - City:COUNCE
Practice Address - State:TN
Practice Address - Zip Code:38326
Practice Address - Country:US
Practice Address - Phone:731-689-5232
Practice Address - Fax:731-689-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3383380Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER