Individual
DR. BARRY JOHN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
256 N 2ND E, REXBURG, ID 83440-1638
(208) 656-9646
(208) 656-9645
Mailing address
256 N 2ND E, REXBURG, ID 83440-1638
(208) 656-9646
(208) 656-9645
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
O-0522
ID
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
O-0522
ID
Other
Enumeration date
06/27/2007
Last updated
06/11/2014
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