Individual
CARL PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12348 OLD TESSON RD, SUITE 180, SAINT LOUIS, MO 63128-2251
(314) 467-2014
(314) 467-2170
Mailing address
12348 OLD TESSON RD, SUITE 180, SAINT LOUIS, MO 63128-2251
(314) 467-2014
(314) 467-2170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036099983
IL
207Q00000X
Family Medicine Physician
Primary
2009012802
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099983
—
IL
05
—
205521800
—
MO
Enumeration date
09/29/2006
Last updated
09/09/2014
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