Organization
JOHN P PETERSEN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PETER PETERSEN MD (PHYSICIAN)
(772) 794-3333
Entity
Organization
Contact information
Practice address
3555 10TH CT, VERO BEACH, FL 32960-5013
(772) 794-3333
(772) 569-6949
Mailing address
PO BOX 100013, ATLANTA, GA 30384-0013
(770) 693-5818
(770) 693-5821
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374792100
—
FL
01
—
920004346
RAILROAD MEDICARE
FL
Enumeration date
04/12/2007
Last updated
03/25/2020
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