Provider Demographics
NPI:1457543399
Name:PETERS, GEOFFREY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MICHAEL
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 2121
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810
Practice Address - Country:US
Practice Address - Phone:228-767-7200
Practice Address - Fax:225-767-7386
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPGY.LSUN.OTOLAR207Y00000X
LA202772207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035360Medicaid
4Q977DR48Medicare PIN