Individual
WALTER RUSSELL PETERS JR.
Active
Individual
WALTER RUSSELL PETERS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.B.A
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
R6G45
MO
208C00000X
Colon & Rectal Surgery Physician
Primary
Q6358
TX
208C00000X
Colon & Rectal Surgery Physician
R6G45
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123497
PHCS
MO
01
—
1284609
UNITED HEALTHCARE
MO
01
—
1316941123
NPI
TX
05
—
202523015
—
MO
01
—
25055
ANTHEM BLUECROSS BLUESHIE
MO
01
—
28058
GHP
MO
05
—
3548646-01
—
TX
01
—
431428562
GREAT WEST
MO
01
—
4343317
AETNA
MO
01
—
4343317
AETNA
TX
01
—
5125
HEALTHCARE USA
MO
01
—
8FM794
BCBS
TX
01
—
A10787
MERCY
MO
Enumeration date
06/09/2005
Last updated
04/07/2022
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