Individual
MR. JAY WILLIAM PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2305 GENOA BUSINESS PARK DR, SUITE 170, BRIGHTON, MI 48114-7367
(810) 299-8550
(810) 844-0837
Mailing address
2305 GENOA BUSINESS PARK DR, SUITE 170, BRIGHTON, MI 48114-7367
(810) 299-8550
(810) 844-0837
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
JP004176
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D71023
BCBSM
MI
01
—
JP004176
MI LICENSE #
MI
Enumeration date
03/23/2006
Last updated
06/07/2011
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