Individual
EVAN DOUGLAS PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6520 SE 14TH ST, DES MOINES, IA 50320-1846
(515) 953-1500
(515) 953-2136
Mailing address
103 SW 3RD ST APT 403, DES MOINES, IA 50309-4832
(515) 577-6220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
088343
IA
363A00000X
Physician Assistant
Primary
088343
IA
Other
Enumeration date
08/01/2017
Last updated
10/30/2024
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