Individual
LARYN A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8040 CLEARVISTA PKWY STE 350, INDIANAPOLIS, IN 46256-4673
(317) 844-7059
(317) 819-0044
Mailing address
9002 N MERIDIAN ST STE 222, INDIANAPOLIS, IN 46260-5350
(317) 819-4516
(317) 819-0044
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01031101A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040014115
MEDICARE RAILROAD
IN
05
—
100226860
—
IN
01
—
P01157080
MEDICARE RR
IN
Enumeration date
01/03/2007
Last updated
06/18/2021
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