Provider Demographics
NPI:1760461032
Name:PETERS, CHRISTOPHER CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CARL
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 1:2751 OAKDALE BLVD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9749
Mailing Address - Country:US
Mailing Address - Phone:319-665-2870
Mailing Address - Fax:319-665-2872
Practice Address - Street 1:2751 OAKDALE BLVD
Practice Address - Street 2:SUITE #2
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9749
Practice Address - Country:US
Practice Address - Phone:319-665-2870
Practice Address - Fax:319-665-2872
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35756208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00199749OtherRAILROAD MEDICARE
IA0454504Medicaid
IA77 0641286 02OtherJOHN DEERE
IA37091OtherBCBS
IAG56582Medicare UPIN
IA37091OtherBCBS