Individual
BART J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3 MEDICAL PLAZA DR STE 140, ROSEVILLE, CA 95661-3088
(916) 865-1400
Mailing address
PO BOX 255228, SACRAMENTO, CA 95865-5228
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21631
CA
363A00000X
Physician Assistant
PA723
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA723
LICENSE NUMBER
ID
Enumeration date
12/12/2007
Last updated
04/26/2023
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