Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35.094078 | OH |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0069815 | MD |
NPI | 1689708596 |
---|---|
Provider Name | Dr. Paul Gregory Peters |
First Address | Beavercreek, OH 45431-3841 |
Second Address | Beavercreek, OH 45431-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 26/10/2021 |