Provider Demographics
NPI:1831453026
Name:PETERS, ANDREW S (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:PETERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 ABBOTT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4450
Mailing Address - Country:US
Mailing Address - Phone:907-522-7090
Mailing Address - Fax:907-522-7095
Practice Address - Street 1:2121 ABBOTT RD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4450
Practice Address - Country:US
Practice Address - Phone:907-522-7090
Practice Address - Fax:907-522-7095
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02004248A207Q00000X
AK165286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program