Individual
DARREN L PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 414-9558
(806) 354-5693
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9558
(806) 354-5693
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME95971
FL
208600000X
Surgery Physician
Primary
Q2367
TX
2086S0102X
Surgical Critical Care Physician
Q2367
TX
2086X0206X
Surgical Oncology Physician
Q2367
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200565240 A
—
OK
05
—
2768488-00
—
FL
05
—
32522746
—
NM
05
—
342173701
—
TX
05
—
342173702
—
TX
01
—
40181D
MEDICARE HCP GROUP
FL
05
—
454214962A
—
GA
Enumeration date
08/22/2006
Last updated
03/31/2015
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