Individual
DEAN KYLE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19300 SW 65TH AVE, TUALATIN, OR 97062
(503) 413-8407
(503) 413-6951
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
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
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