Basic Information
| Provider Information | |||||||||
| NPI: | 1912439506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 DAGGETT AVE | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418826311 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2821 DAGGETT AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412748400 | ||||||||
| FaxNumber: | 5412748405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2017 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD187759 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.