Individual
JOLYON DAVID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 PACIFIC AVE, TACOMA, WA 98402-3302
(253) 680-6016
Mailing address
1501 PACIFIC AVE, TACOMA, WA 98402-3302
(253) 680-6016
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12819
WA
207P00000X
Emergency Medicine Physician
MD00012819
WA
207Q00000X
Family Medicine Physician
Primary
MD00012819
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8288003
—
WA
Enumeration date
05/01/2006
Last updated
03/17/2015
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