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Individual
TREVOR PETERSON
Active
Individual
TREVOR PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA213384
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Enumeration date
09/03/2021
Last updated
08/07/2024
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