Individual
TIMOTHY PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
MD31615
TN
2080P0208X
Pediatric Infectious Diseases Physician
Primary
2007-00114
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145YK
BCBS
—
01
—
196290
MEDCOST
—
05
—
3810008320
—
WV
05
—
5906322
—
NC
01
—
7093512
AETNA
—
01
—
810655
PARTNERS
—
05
—
Q00114
—
SC
Enumeration date
10/09/2006
Last updated
01/18/2012
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