Individual
DR. CRAIG A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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