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Individual
DR. WYLAN CORNELIUS PETERSON
Active
Individual
DR. WYLAN CORNELIUS PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Q0151
TX
208600000X
Surgery Physician
35-08-5446
OH
208600000X
Surgery Physician
Q0151
TX
2086S0102X
Surgical Critical Care Physician
Primary
Q0151
TX
Other
Enumeration date
07/26/2006
Last updated
10/12/2026
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