Basic Information
| Provider Information | |||||||||
| NPI: | 1386686137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 WOODMONT BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152972700 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 21581 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 2080P0214X | 021581 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 207RC0200X | 021581 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | 021581 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 164099509 | 01 | TN | UNITED HEALTHCARE | OTHER | 2092886 | 01 | TN | CIGNA | OTHER | 4018883 | 01 | TN | BLUE CROSS OF TN | OTHER | TN0190 | 01 | TN | AMERICHOICE-TENNCARE ONLY | OTHER | 10077103 | 01 | TN | AMERIGROUP-TNCARE AND MCR ADVANTAGE | OTHER | 5557149 | 01 | TN | AETNA | OTHER | 1508914 | 05 | TN | MEDICAID | 1100342185 | 01 | TN | USA PPO-GEHA | OTHER | 12255039 | 01 | TN | MULTIPLAN/PHCS | OTHER | 849925 | 01 | TN | USA-MCO | OTHER | 290013797 | 01 | TN | MEDICARE RR | OTHER | 64920762 | 05 | KY | MEDICAID |