Organization
PETERSON MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADEN PETERSON NP (MEMBER)
(580) 235-1657
Entity
Organization
Contact information
Practice address
217 N HARRISON AVE, BLANCHARD, OK 73010-6211
(405) 631-0611
Mailing address
701 NE 36TH ST, OKLAHOMA CITY, OK 73105-7203
(405) 631-0611
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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