Individual
PETER T HETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1212 PLEASANT ST, SUITE 300, DES MOINES, IA 50309-1453
(515) 241-8923
(515) 241-8728
Mailing address
1212 PLEASANT ST, SUITE 300, DES MOINES, IA 50309-1453
(515) 241-8923
(515) 241-8728
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1833
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205822038
—
IA
01
—
175150053
MEDICARE
—
05
—
246763700
—
MO
Enumeration date
09/27/2005
Last updated
11/17/2011
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