Individual
MARK STEVEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
925 COMMERCIAL ST SE STE 102, SALEM, OR 97302-4173
(503) 561-7227
(503) 671-8334
Mailing address
925 COMMERCIAL ST SE STE 102, SALEM, OR 97302-4173
(503) 561-7227
(503) 371-8334
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD16135
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010509
—
OR
Enumeration date
11/20/2006
Last updated
10/07/2020
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