Individual
ALAN C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7910 W JEFFERSON BLVD, SUITE 102, FORT WAYNE, IN 46804-4159
(260) 432-2297
(260) 434-6420
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01031812A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0518649
—
OH
05
—
100096130
—
IN
05
—
2907251
—
MI
01
—
330005240
RR MEDICARE
IN
Enumeration date
08/11/2005
Last updated
09/29/2020
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