Bryan Thomas Peters
Individual provider Active NPI Contractor · Opelika, AL
NPI 1669150264 · NPPES record last updated Jul 5, 2023
Key facts
- NPI
- 1669150264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 1676 (AL)
- Practice address
- 3503 Tifton LN
Opelika, AL 36804-7651 - Phone
- (334) 559-4673
- NPI assigned
- Jul 5, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1676 | AL | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enable Medical LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 1676 | AL | Yes |
Addresses
Primary practice location
3503 Tifton LN
Opelika, AL 36804-7651
Mailing address
3503 Tifton LN
Opelika, AL 36804-7651
Phone (334) 559-4673
Other providers in Opelika, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.