Provider Demographics
NPI:1497731806
Name:PETERS, JOHN HAILE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAILE
Last Name:PETERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1237 ANTELOPE AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-5910
Mailing Address - Country:US
Mailing Address - Phone:530-297-5556
Mailing Address - Fax:
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:SACRAMENTO VA MEDICAL CENTER
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655
Practice Address - Country:US
Practice Address - Phone:916-843-7153
Practice Address - Fax:916-364-0306
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG46558207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine