| Doctor Name: | DR. JOHN CLEVE PETERSON |
| NPI Number: | 1023111002 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., M.P.H. |
| License Number: | 11059 |
| Business Practice Address: | 7030 N Mercer Way Mercer Island, WA - 980402130 |
| Business Phone Number: | 2062327669 |
| Business Fax Number: | 2062327679 |
| Mailing Address: | 7030 N Mercer Way, MERCER ISLAND |
| State: | WA |
| Postal Code: | 980402130 |
| Phone Number: | 2062327669 |
| Fax Number: | 2062327679 |
| NPI Enumeration Date: | 09/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 11059 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |