Provider Demographics
NPI:1821091935
Name:PETERS, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8897
Mailing Address - Country:US
Mailing Address - Phone:317-398-0121
Mailing Address - Fax:317-398-2335
Practice Address - Street 1:30 W RAMPART ST
Practice Address - Street 2:STE 210
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8897
Practice Address - Country:US
Practice Address - Phone:317-398-0121
Practice Address - Fax:317-398-2335
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01026337A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100321420AMedicaid
INP00459131OtherRAILROAD MEDICARE PIN
INE03811Medicare UPIN
IN0175050001Medicare NSC
IN100321420AMedicaid