Individual
DR. TINA A PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 UNIVERSITY OF NEW MEXICO, MSC10 5590, ALBUQUERQUE, NM 87131-0001
(505) 272-3909
Mailing address
PO BOX 36302, ALBUQUERQUE, NM 87176-6302
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD2010-0502
NM
208000000X
Pediatrics Physician
Primary
RS20070349
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD2010-0502
NEW MEXICO MEDICAL BOARD
NM
01
—
RS20070349
TRAINING
NM
Enumeration date
04/19/2007
Last updated
09/03/2010
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