Individual
DR. THEA E PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1515 VILLAGE DR STE 220, COTTAGE GROVE, OR 97424-9700
(541) 767-5200
(541) 767-5353
Mailing address
PO BOX 24410, EUGENE, OR 97401
(541) 984-4301
(541) 335-2527
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD152665
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2008
Last updated
04/10/2023
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