Individual
DR. CANDY L PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 MAIN STREET, LOVINGTON, NM 88260-2871
(575) 396-6611
Mailing address
1600 MAIN STREET, LOVINGTON, NM 88260
(575) 396-6611
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
MD2020-0642
NM
207Q00000X
Family Medicine Physician
42413
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33343300
—
WI
01
—
434T0VO
BLUE CROSS BLUE SHIELD
WI
05
—
4595645
—
MI
Enumeration date
09/23/2006
Last updated
02/09/2023
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