Individual
DAVID A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3612 DALE RD, MODESTO, CA 95356-0500
(209) 522-0146
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G61388
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G613880
—
CA
Enumeration date
05/10/2006
Last updated
06/11/2019
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