Organization
ROBERT G PETERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA H PETERSON RN (OFFICE MANAGER)
(336) 835-7208
Entity
Organization
Contact information
Practice address
680 PARKWOOD MEDICAL PARK, ELKIN, NC 28621-2487
(336) 835-7208
(336) 835-7209
Mailing address
680 PARKWOOD MEDICAL PARK, ELKIN, NC 28621-2487
(336) 835-7208
(336) 835-7209
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017RA
BLUE CROSS
NC
01
—
2255
PARTNERS MEDICARE CHOICE
NC
01
—
2330424
MEDICARE-PTAN
NC
05
—
5902795
—
NC
Enumeration date
04/16/2007
Last updated
02/22/2013
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