Provider Demographics
NPI:1942389929
Name:PETERS, LAURIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:J
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6600 MERCY COURT
Mailing Address - Street 2:SUITE 290
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3190
Mailing Address - Country:US
Mailing Address - Phone:916-962-0021
Mailing Address - Fax:916-962-0029
Practice Address - Street 1:6600 MERCY COURT
Practice Address - Street 2:SUITE 290
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3190
Practice Address - Country:US
Practice Address - Phone:916-962-0021
Practice Address - Fax:916-962-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG274322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43352Medicare UPIN
CA00G274320Medicare ID - Type Unspecified