Individual
JOHNATHAN L. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
204 E FAIR OAKS PL, SAN ANTONIO, TX 78209-3811
(210) 315-4601
Mailing address
204 E FAIR OAKS PL, SAN ANTONIO, TX 78209-3811
(210) 315-4601
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA05099
TX
Other
Enumeration date
11/28/2006
Last updated
02/06/2025
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