Individual
GORDON W PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11370 ANDERSON ST STE B-100, LOMA LINDA, CA 92354
(909) 558-2880
Mailing address
54701 FILE NUMBER, LOS ANGELES, CA 90074-4701
(909) 558-3905
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G31371
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G313710
—
CA
Enumeration date
07/10/2006
Last updated
07/20/2018
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