Basic Information
| Provider Information | |||||||||
| NPI: | 1457543399 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | SUITE 2121 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2287677200 | ||||||||
| FaxNumber: | 2257677386 | ||||||||
| Practice Location | |||||||||
| Address1: | 8080 BLUEBONNET BLVD | ||||||||
| Address2: | SUITE 2121 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2287677200 | ||||||||
| FaxNumber: | 2257677386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 06/28/2012 | ||||||||
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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 | 207Y00000X | PGY.LSUN.OTOLAR | LA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 202772 | LA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1035360 | 05 | LA | MEDICAID |