Individual
MR. ERIC SCOTT PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
918 W PLATT ST # 1, MAQUOKETA, IA 52060-2038
(563) 652-5145
(563) 652-3674
Mailing address
918 W PLATT ST # 1, MAQUOKETA, IA 52060-2038
(563) 652-5145
(563) 652-3674
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03059
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03059
IOWA LICENSE
IA
01
—
080120570
RAILROAD MEDICARE
IA
05
—
1147512
—
IA
05
—
2147512
—
IA
01
—
4210571962002
JOHN DEERE HEALTHCARE
IA
01
—
44479
WELLMARK BLUE CROSS
IA
Enumeration date
01/19/2006
Last updated
03/07/2023
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