Organization
JOSEPH R. PETERSEN, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH R PETERSEN (MD/OWNER)
(208) 678-1138
Entity
Organization
Contact information
Practice address
1344 HILAND AVE, SUITE A, BURLEY, ID 83318-1564
(208) 678-1138
(208) 678-5833
Mailing address
PO BOX 1263, BURLEY, ID 83318-0859
(208) 678-1138
(208) 678-5833
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225105604
—
ID
Enumeration date
01/22/2014
Last updated
07/21/2022
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