Provider Demographics
NPI:1538141320
Name:PETERS, GORDON CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:CHARLES
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:PSC 103
Mailing Address - Street 2:POB 3805
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09603
Mailing Address - Country:IT
Mailing Address - Phone:043-430-5056
Mailing Address - Fax:
Practice Address - Street 1:UNIT 6180 BOX 245
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604
Practice Address - Country:IT
Practice Address - Phone:043-430-5056
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060760P2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine