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Organization
CPO PSC
Active
Organization
CPO PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE H PETERS MD (MD)
(502) 366-0970
Entity
Organization
Contact information
Practice address
4402 CHURCHMAN AVE, SUITE 404, LOUISVILLE, KY 40215-1190
(502) 363-4156
Mailing address
PO BOX 30563, BELFAST, ME 04915-2057
(888) 488-8289
(502) 919-9780
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
31716
KY
332B00000X
Durable Medical Equipment & Medical Supplies
31716
KY
363LF0000X
Family Nurse Practitioner
5222
KY
Other
Enumeration date
08/12/2006
Last updated
05/27/2022
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