Provider Demographics
NPI:1245258789
Name:PETERS, WALTER JAMES JR (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 S WHEELING AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5642
Mailing Address - Country:US
Mailing Address - Phone:918-747-3937
Mailing Address - Fax:918-748-8707
Practice Address - Street 1:7171 S YALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6367
Practice Address - Country:US
Practice Address - Phone:918-307-0496
Practice Address - Fax:918-461-1609
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-10-27
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Provider Licenses
StateLicense IDTaxonomies
OK20269207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10045980AMedicaid
OK10045980AMedicaid
H13231Medicare UPIN