Individual
JAMES D PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 234-4700
Mailing address
500 S 11TH AVE STE 400, POCATELLO, ID 83201-4880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MRM-2027
ID
Other
Enumeration date
05/21/2021
Last updated
05/24/2021
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