Individual
JON PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10151 SE SUNNYSIDE RD STE 100, CLACKAMAS, OR 97015-5705
(503) 659-0880
(503) 513-7425
Mailing address
10151 SE SUNNYSIDE RD STE 100, CLACKAMAS, OR 97015-5705
(503) 659-0880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18051
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048194004
BLUE CROSS BLUE SHIELD
OR
05
—
050471
—
OR
01
—
080061183
RAILROAD MEDICARE PIN
OR
05
—
8125841
—
WA
Enumeration date
08/01/2006
Last updated
05/11/2021
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