Individual
MR. DAVID ANDREW PETERSON JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
NOMI DET NUMI SUBMARINE BASE NLON, BUILDING 159, GROTON, CT 06349
(860) 694-2876
(860) 694-3874
Mailing address
125 HICKORY ST, NORWICH, CT 06360-4634
(860) 514-5293
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDENT DUTY CORPSMAN
—
Enumeration date
03/08/2006
Last updated
07/08/2007
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