Provider Demographics
NPI:1568461747
Name:PETERS, ANTHONY G (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:G
Last Name:PETERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2501
Mailing Address - Country:US
Mailing Address - Phone:712-722-2609
Mailing Address - Fax:712-722-8426
Practice Address - Street 1:1101 9TH ST SE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-2501
Practice Address - Country:US
Practice Address - Phone:712-722-2609
Practice Address - Fax:712-722-8426
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0484363AM0700X
IA002094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9245667OtherDAKOTACARE
SDAH9141049452OtherPREFERRED ONE
SD4993250OtherBLUE CROSS
IA002094OtherIA PHYSICIAN ASSISTANTS LICENSURE
SD6823833Medicaid
SD0484OtherSTATE LICENSE NUMBER
MP0750047OtherDEA REGISTRATION NUMBER
SDS7996Medicare PIN
SD4993250OtherBLUE CROSS