Individual
RUSSELL D PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
965 US HWY 431, ROANOKE, AL 36274
(334) 863-2141
(334) 863-8733
Mailing address
PO BOX 625, ROANOKE, AL 36274-0625
(334) 863-2141
(334) 863-8733
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO436
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000091244
—
AL
01
—
51091244
BCBS OF ALABAMA
AL
Enumeration date
09/05/2006
Last updated
07/08/2007
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