Provider Demographics
NPI:1477501906
Name:PETERS, MICHAEL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WAYNE
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 1:5104 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0237
Mailing Address - Country:US
Mailing Address - Phone:256-878-8180
Mailing Address - Fax:256-891-3693
Practice Address - Street 1:5104 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0237
Practice Address - Country:US
Practice Address - Phone:256-878-8180
Practice Address - Fax:256-891-3693
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000004958Medicaid
AL051004958OtherBLUE CROSS BLUE SHIELD
AL000004958OtherMEDICARE
AL051004958OtherBLUE CROSS BLUE SHIELD
ALC72697Medicare UPIN
AL000004958OtherMEDICARE