Organization
PETERSEN CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE N. PETERSEN DO (CO-OWNER)
(304) 465-0544
Entity
Organization
Contact information
Practice address
119 MAIN ST W, SUITE A, OAK HILL, WV 25901-2943
(304) 465-0544
(304) 465-8832
Mailing address
119 MAIN ST W, SUITE A, OAK HILL, WV 25901-2943
(304) 465-0544
(304) 465-8832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1864
WV
207Q00000X
Family Medicine Physician
942
WV
207R00000X
Internal Medicine Physician
Primary
941
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0084786001
—
WV
Enumeration date
07/04/2006
Last updated
09/11/2025
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