Individual
DR. CRAIG A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1229 E SEMINOLE ST, SPRINGFIELD, MO 65804-2227
(417) 820-9393
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
R7E36
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111851001
—
AR
05
—
202118733
—
MO
01
—
22698
MO BLUE SHIELD
MO
01
—
81582
ARK BLUE SHIELD
AR
Enumeration date
02/15/2007
Last updated
10/18/2011
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