Individual
THOMAS R PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 E THIRD ST, CHATTANOOGA, TN 37403-2147
(423) 778-7608
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD17828
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000370829C
—
GA
05
—
009102570
—
AL
01
—
050013519
MEDICARE RAILROAD
TN
05
—
3028382
—
TN
01
—
3039778
BLUE CROSS BLUE SHIELD TN
TN
05
—
890692J
—
NC
01
—
N348391
WELLCARE (GA MEDICAID)
GA
Enumeration date
11/20/2006
Last updated
01/14/2010
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