Individual
KEITH E PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-1000
(253) 968-1340
Mailing address
9040 JACKSON AVE 9040 JACKSON STREET, TACOMA, WA 98431-1000
(253) 968-1340
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
60595760
WA
Other
Enumeration date
03/07/2012
Last updated
03/12/2024
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