| Doctor Name: | MARY T CARR PETERSON |
| NPI Number: | 1164496212 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 001597 |
| Business Practice Address: | 600 Linn St Ste B Slater Medical Clinic Slater, IA - 50244 |
| Business Phone Number: | 5156853960 |
| Business Fax Number: | 5156853961 |
| Mailing Address: | 600 Linn St, Suite B SLATER |
| State: | IA |
| Postal Code: | 50244 |
| Phone Number: | 5156853960 |
| Fax Number: | 5156853961 |
| NPI Enumeration Date: | 02/15/2006 |
| NPI Last Update Date: | 08/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 001597 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |