Individual
GLEN W. PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
411 30TH ST, SUITE 314, OAKLAND, CA 94609-3312
(510) 465-6800
(510) 268-0634
Mailing address
411 30TH ST, SUITE 314, OAKLAND, CA 94609-3312
(510) 841-0689
(510) 841-8119
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A26004
CA
207RP1001X
Pulmonary Disease Physician
Primary
A26004
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A260040
—
CA
Enumeration date
06/13/2006
Last updated
01/14/2016
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