Organization Name: | JOSEPH R. PETERSEN, M.D. |
NPI Number: | 1790956514 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH R PETERSEN (PHYSICIAN/OWNER) |
Mailing Address: | 1344 Hiland Ave Ste A Burley |
State: | ID US |
Postal Code: | 833181564 |
Phone Number: | 2086781138 |
Fax Number: | 2086785833 |
NPI Enumeration Date: | 03/19/2008 |
NPI Last Update Date: | 03/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | M5283 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |