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Individual

DR. JAMES ALLEN KRAFT PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
145 OAK MEADOW RD, SIERRA MADRE, CA 91024-2661
(415) 793-3269
(702) 384-1815
Mailing address
2020 PALOMINO LANE, SUITE 100, LAS VEGAS, NV 89106-4894
(702) 759-8600
(702) 384-1815

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
20A8715
CA
2085R0202X
Diagnostic Radiology Physician
Primary
20A8715
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1376545863
CA
05
1376545863
NV
01
P01361869
RR MEDICARE DRS
CA
01
P01361871
RR MEDICARE DR
CA
Enumeration date
08/15/2005
Last updated
11/05/2014
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