Provider Demographics
NPI:1669404422
Name:FOOTE, PETER J (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:FOOTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21 BELMONT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7110
Mailing Address - Country:US
Mailing Address - Phone:802-257-7792
Mailing Address - Fax:802-254-7001
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-257-7792
Practice Address - Fax:802-254-7001
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07656100207Q00000X
VT0320069794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1018240Medicaid