Provider Demographics
NPI:1760457907
Name:PETERS, THOMAS GUY (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GUY
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:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-0646
Mailing Address - Fax:352-265-0678
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0646
Practice Address - Fax:352-265-0678
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52942204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000477551CMedicaid
FL0640565-00Medicaid
FLP00228295OtherRAILROAD MEDICARE
FLB03181Medicare UPIN
FL09306WMedicare PIN
FL0640565-00Medicaid