Provider Demographics
NPI:1659380798
Name:PETERS, BROOKS A (DPM)
Entity Type:Individual
Prefix:
First Name:BROOKS
Middle Name:A
Last Name:PETERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2311
Mailing Address - Country:US
Mailing Address - Phone:215-257-5170
Mailing Address - Fax:215-257-9566
Practice Address - Street 1:109 NOBLE ST
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-2311
Practice Address - Country:US
Practice Address - Phone:215-257-5170
Practice Address - Fax:215-257-9566
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003137L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480006513OtherRAILROAD MEDICARE PALMETT
PA2701176OtherEVERCARE
PA041185035Medicaid
PA0081163000OtherINDEPENDENCE BLUE CROSS