Provider Demographics
NPI:1659432250
Name:PETERS, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:500 E WINDMILL LN
Mailing Address - Street 2:STE 125
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1845
Mailing Address - Country:US
Mailing Address - Phone:702-263-4795
Mailing Address - Fax:702-263-4804
Practice Address - Street 1:105 N PECOS RD
Practice Address - Street 2:STE113
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1995
Practice Address - Country:US
Practice Address - Phone:702-263-4795
Practice Address - Fax:702-263-4804
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG79874Medicare UPIN
NVV35095Medicare PIN