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Individual
MICHAEL JAKE PETERSEN
Active
Individual
MICHAEL JAKE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A191321
CA
2080S0010X
Pediatric Sports Medicine Physician
Primary
MD.MD.61679347
WA
Other
Enumeration date
04/30/2019
Last updated
04/11/2026
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