Individual
ANTHONY G PETERS
Active
Individual
ANTHONY G PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002094
IA
363AM0700X
Medical Physician Assistant
0484
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002094
IA PHYSICIAN ASSISTANTS LICENSURE
IA
01
—
0484
STATE LICENSE NUMBER
SD
01
—
4993250
BLUE CROSS
SD
05
—
6823833
—
SD
01
—
9245667
DAKOTACARE
SD
01
—
AH9141049452
PREFERRED ONE
SD
Enumeration date
07/19/2005
Last updated
03/07/2023
Update your record
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