Individual
PAUL DAVID PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
17851
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100173870A
—
OK
01
—
4207831
AETNA
—
01
—
7822481
CIGNA
—
Enumeration date
06/23/2006
Last updated
02/10/2017
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