Individual
ALISA GAY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
411 N BELKNAP ST, STEPHENVILLE, TX 76401-3415
(254) 965-1152
(254) 965-1156
Mailing address
PO BOX 910042, DALLAS, TX 75391-0042
(972) 788-1692
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L7109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161152702
—
TX
01
—
8F3319
BLUE CROSS BLUE SHIELD
TX
01
—
P00322298
RAILROAD MEDICARE
TX
01
—
TX6027610
CHAMPUS
TX
Enumeration date
02/28/2006
Last updated
05/21/2008
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