| Doctor Name: | ROY C. PETERSON |
| NPI Number: | 1164662714 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G036719 |
| Business Practice Address: | 115 West E Street Tehachapi, CA - 935811900 |
| Business Phone Number: | 6619722874 |
| Business Fax Number: | 6618238106 |
| Mailing Address: | 20322 Oakdale Ln, TEHACHAPI |
| State: | CA |
| Postal Code: | 935617649 |
| Phone Number: | 6619722874 |
| Fax Number: | 6618238106 |
| NPI Enumeration Date: | 02/23/2009 |
| NPI Last Update Date: | 03/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | G036719 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |