Individual
CODY ALLEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(208) 417-7569
Mailing address
9382 E BAHIA DR STE B202, SCOTTSDALE, AZ 85260-1580
(208) 417-7569
(480) 585-0051
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
TLM-4130
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/17/2017
Last updated
06/25/2020
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