Individual
MICHAEL THEODORE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 754-4710
(541) 574-2858
Mailing address
PO BOX 366, CORVALLIS, OR 97339-0366
(541) 758-5047
(541) 758-3713
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD09375
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279000
—
OR
Enumeration date
10/11/2006
Last updated
05/07/2008
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