Individual
DONALD DOUGLAS PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
408 8TH ST, 1ST FLOOR, NORTH WILKESBORO, NC 28659-4167
(336) 838-4158
(336) 838-5361
Mailing address
PO BOX 159, NORTH WILKESBORO, NC 28659-0159
(336) 838-4158
(336) 838-5361
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
21502
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10534
PARTNERS
—
01
—
1907386
UHC
—
01
—
201833B
PSC MEDICARE PROVIDER
NC
01
—
299906
MAMSI
—
01
—
34550
MEDCOST
—
01
—
67213
BCBS
—
01
—
6805098005
CIGNA
—
05
—
8967213
—
NC
Enumeration date
07/12/2005
Last updated
08/07/2007
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