Individual
JOHN CHARLES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2423 W JACKSON ST, MUNCIE, IN 47303-4734
(765) 282-7475
(765) 282-1108
Mailing address
2423 W JACKSON ST, MUNCIE, IN 47303-4734
(765) 282-7475
(765) 282-1108
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10027232
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106190A
—
IN
Enumeration date
07/26/2006
Last updated
04/22/2025
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