Individual
BRENT P PETERSON
Active
Individual
BRENT P PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
2003013356
MO
207T00000X
Neurological Surgery Physician
Primary
E-11020
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100641320A
—
KS
05
—
209001809
—
MO
01
—
P00046311
RR MEDICARE
MO
Enumeration date
07/07/2006
Last updated
01/10/2019
Update your record
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