DR. GERALD E PETERS JR. (NPI# 1891703021) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891703021 |
| Entity Type | Individual |
| Full Name | DR. GERALD E PETERS JR. |
| Credential | M.D. |
| Practice Address |
2041 Ne Williamson Ct Ste B Bend OR 97701-3925 |
| Practice Telephone | 5413237546 |
| Practice Fax Number | 5415413234 |
| Mailing Telephone | 5413237546 |
| Mailing Fax Number | 5415413234 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2016-04-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | MD25927 | OR | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD25927 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE RAILROAD | 00479104 | 01 |
| OR | 269917 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615112 | Gerald J Peters | Counselor | 916 N Mountain Ave Ste A, Upland, CA 91786-3658 | 2012-11-05 |
| 1447255518 | Gerald Kent Peters | Chiropractor | 8404 W 13th St N, Suite 150, Wichita, KS 67212-2978 | 2005-06-16 |
| Street Address |
2041 NE WILLIAMSON CT STE B |
| City | BEND |
| State | OR |
| Zip Code | 97701-3925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871954214 | Peters Dermatology Center | Dermatology | 2041 Ne Williamson Ct, Ste B, Bend, OR 97701-3925 | 2016-03-13 |
| 1821419243 | Stefan Lindenau | Denturist | 2041 Ne Williamson Ct, Suite C, Bend, OR 97701-3925 | 2014-01-03 |
| 1316104615 | Bend Spine & Pain Specialists, LLC | Clinic/Center | 2041 Ne Williamson Ct, Suite B, Bend, OR 97701-3925 | 2008-05-22 |
| 1073624094 | Ann M Reitan | Physician Assistant | 2041 Ne Williamson Ct, Ste B, Bend, OR 97701-3925 | 2006-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104465525 | Andrew Kyle Burzynski | Denturist | 853 Ne 4th St., Bend, OR 97701 | 2020-01-02 |
| 1013480714 | Andrew Traut | Specialist/Technologist | Oregon State Force Lab, 2200 Ne Neff Rd Suite 202, Bend, OR 97701 | 2019-01-04 |
| 1871063917 | Calley Asbill, Nd LLC | Chiropractor | 2146 Ne 4th Street, Suite 160, Bend, OR 97701 | 2018-12-02 |
| 1902372212 | Carisa S Battin | Counselor | 361 Ne Franklin Avenue Bldg E #4, Bend, OR 97701 | 2018-10-15 |
| 1366921223 | Hillside Eye Center LLC | Ophthalmology | 625 Nw Colorado Avenue, Bend, OR 97701 | 2018-08-11 |
| 1528545514 | Kellie Michiko Kawasaki-jones | Dentist | 62968 Ob Riley Road, Suite 12, Bend, OR 97701 | 2018-07-23 |
| 1992255327 | Shelby Chiropractic | Chiropractor | 561 Ne Bellevue Dr Ste 102, Bend, OR 97701 | 2016-10-10 |
| 1144671520 | Kevin Richard Pett | Acupuncturist | 39 Nw Louisanna Ave., Hawthorn Healing Arts Center, Bend, OR 97701 | 2016-06-27 |
| 1912357500 | Sheldon Shawn Doveri | Driver | 233 Nw Revere Ave, Bend, OR 97701 | 2016-06-15 |
| 1740647411 | Anne Power | Homeopath | 2100 Ne Neff Rd Suite B, Bend, OR 97701 | 2016-01-26 |
| Find all providers in zip 97701 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447713573 | Dermatology Health Specialists, PC | Dermatology | 1693 Sw Chandler Ave Ste 250, Bend, OR 97702-3231 | 2019-04-06 |
| 1780846501 | Bend Memorial Clinic PC | Dermatology | 2600 Ne Neff Rd, Bend, OR 97701-6337 | 2008-07-02 |
| 1184643249 | William J Delgado | Dermatology | 2705 Ne Conners Ave, Bend, OR 97701-6904 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871574947 | Edgar Maeyens | Dermatology | 375 Park Ave, Suite 5, Coos Bay, OR 97420-2242 | 2005-11-07 |
| 1972913259 | Lindsey Fix | Dermatology | 1605 G St, Springfield, OR 97477 | 2014-05-07 |
| 1558515494 | Jay Y Park Md, PC | Dermatology | 360 S Garden Way Ste 230, Eugene, OR 97401-8173 | 2008-11-05 |
| 1700081742 | Richard I. Ecker | Dermatology | 706 Ne Evans St, Mcminnville, OR 97128-3926 | 2007-06-19 |
| 1396845814 | Parwathi Vasudeva Paniker | Dermatology | 3600 N Interstate Ave, Portland, OR 97227-1106 | 2006-09-24 |
| 1205805405 | Stephen N Snow | Dermatology | 3600 N Interstate Ave, Dermatology/mohs Surg Central Interstate Medical Office, Portland, OR 97227-1106 | 2006-03-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.