Carl Wade Peters Jr., M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME0050581 Issued in FL

Practice address

2301 N 9TH Ave
Suite 200
Pensacola, FL 32503-3950

Phone

(850) 434-1313

Fax

(850) 434-8803

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1265456982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 N 9TH AVE",
            "address_2": "SUITE 200",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325033950",
            "telephone_number": "850-434-1313",
            "fax_number": "850-434-8803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 N 9TH AVE",
            "address_2": "SUITE 200",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325033950",
            "telephone_number": "850-434-1313",
            "fax_number": "850-434-8803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "CARL",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME0050581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046385000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pet LLC
• Peter J. Congiundi, DDS, PA
• Peter N Butler, MD, PA
• Jamieson Taylor Peterman, ARNP
• Jenna Peterman, PA-C
• Dennis Howard Peters, M.D.
• Jessica Seay Peters, NNP-BC
• Kevin Thomas Petersen, D.O.
• Cassidy Peterson, MD
• Erika Noelle Peterson, DPT

• Dermatology Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.