Individual
JOHN DALE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
929 N SAINT FRANCIS ST, WICHITA, KS 67214-3821
(800) 374-5326
(800) 374-7656
Mailing address
PO BOX 356, WICHITA, KS 67201-0356
(844) 468-9498
(855) 630-1302
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
0531672
KS
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
0531672
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200611100A
—
KS
05
—
200611100B
—
KS
01
—
P00727380
RR MEDICARE GROUP CQ2302
KS
Enumeration date
05/01/2007
Last updated
06/06/2025
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