Provider Demographics
NPI:1679545388
Name:PETERS, STEPHEN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:PETERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE #175
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3043
Mailing Address - Country:US
Mailing Address - Phone:916-782-2146
Mailing Address - Fax:916-782-4299
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE #175
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-782-2146
Practice Address - Fax:916-782-4299
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83285207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ069702OtherBLUE SHIELD
CAGROO94900Medicaid
CAGROO94900Medicaid
CAF92977Medicare UPIN
ZZZ26246ZMedicare PIN