Provider Demographics
NPI:1558385526
Name:PETERS, TIMOTHY FRANCIS (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 COMMONS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3841
Mailing Address - Country:US
Mailing Address - Phone:937-424-5825
Mailing Address - Fax:937-424-5829
Practice Address - Street 1:2587 COMMONS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3841
Practice Address - Country:US
Practice Address - Phone:937-424-5825
Practice Address - Fax:937-424-5829
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007086P207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271965Medicaid
OHG93794Medicare UPIN
OH2271965Medicaid