Individual
TIMOTHY D PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
108 SUTTON PLACE, TAOS SKI VALLEY, NM 87525-0067
(575) 766-8421
(575) 776-8942
Mailing address
PO BOX 67, 108 SUTTON PLACE, TAOS SKI VALLEY, NM 87525-0067
(575) 766-8421
(575) 776-8942
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2528
AK
207P00000X
Emergency Medicine Physician
Primary
81-285
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33282
—
NM
Enumeration date
11/21/2005
Last updated
07/12/2016
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