Individual
DEAN KYLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD186971
OR
207R00000X
Internal Medicine Physician
PG178578
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PG178578
OREGON MEDICAL BOARD
OR
Enumeration date
06/25/2013
Last updated
07/05/2018
Update your record
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