Individual
DR. CARL ROY PETERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.S.
Contact information
Practice address
8401 MARKET ST, BOARDMAN, OH 44512-6725
(330) 629-7500
(330) 629-7504
Mailing address
8401 MARKET ST, BOARDMAN, OH 44512-6725
(330) 629-7500
(330) 629-7503
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
35.091496
OH
2085R0001X
Radiation Oncology Physician
Primary
35.123850
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107099
—
OH
Enumeration date
05/04/2009
Last updated
12/29/2016
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