Individual
JARED DAVID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1040 NW 22ND AVE STE 168, PORTLAND, OR 97210-3036
(503) 413-7022
Mailing address
DEPARTMENT OF OPHTHALMOLOGY MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD224449
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
02/15/2021
Last updated
04/08/2025
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