Individual
BRIAN JARED PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1730 ALPINE BLVD STE 109B, ALPINE, CA 91901-3877
(619) 326-4445
(619) 722-1721
Mailing address
2710 ALPINE BLVD # 434, ALPINE, CA 91901-2276
(619) 326-4445
(619) 722-1721
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MA051614
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1061442
NCCPA
—
01
—
MA051614
STATE LICENSE
PA
Enumeration date
10/18/2006
Last updated
03/07/2023
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