Doctor Name: | DR. JOHN M PETERSON |
NPI Number: | 1154404226 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.O. |
License Number: | 032-0000291 |
Business Practice Address: | 72 Barre St Montpelier, VT - 056023508 |
Business Phone Number: | 8022299418 |
Business Fax Number: | 8022295619 |
Mailing Address: | 72 Barre St, MONTPELIER |
State: | VT |
Postal Code: | 056023508 |
Phone Number: | 8022299418 |
Fax Number: | 8022295619 |
NPI Enumeration Date: | 10/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 032-0000291 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |