Provider Demographics
NPI:1962465153
Name:PETERS, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:PETERS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9037 POPLAR AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-235-5753
Mailing Address - Fax:985-223-2604
Practice Address - Street 1:9037 POPLAR AVE
Practice Address - Street 2:STE 101
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-235-5753
Practice Address - Fax:985-223-2604
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-04-28
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Provider Licenses
StateLicense IDTaxonomies
TN59671208200000X
LA021122208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery