Provider Demographics
NPI:1548413503
Name:PETERS, DOUGLAS AHERN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:AHERN
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 1:385 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6714
Mailing Address - Country:US
Mailing Address - Phone:775-737-3360
Mailing Address - Fax:
Practice Address - Street 1:255 GLENDALE AVE.
Practice Address - Street 2:SUITE 12
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-356-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913808Medicaid
NC5913808Medicaid