Individual
MICHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2801 NW MERCY DR STE 300, ROSEBURG, OR 97471-2348
(541) 677-1555
(541) 677-2294
Mailing address
201 NW MEDICAL LOOP STE 190, ROSEBURG, OR 97471-8835
(541) 677-4319
(541) 677-2294
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA197860
OR
Other
Enumeration date
05/01/2019
Last updated
10/01/2020
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