Provider Demographics
NPI:1134424799
Name:PAUL J. PETERS, D.P.M., P.C.
Entity type:Organization
Organization Name:PAUL J. PETERS, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-6677
Mailing Address - Street 1:PO BOX 1940
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-1940
Mailing Address - Country:US
Mailing Address - Phone:561-744-6677
Mailing Address - Fax:561-744-1416
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 4106
Practice Address - Street 2:JUPITER LAKES MEDICAL PARK
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7190
Practice Address - Country:US
Practice Address - Phone:561-744-6677
Practice Address - Fax:561-744-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 528213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8-7224Medicare UPIN
FLT55376Medicare UPIN