Individual
LARRY D. PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-4550
Mailing address
1000 E PRIMROSE ST, SPRINGFIELD, MO 65807-5180
(417) 269-4550
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MDR7D93
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202009619
—
MO
Enumeration date
06/14/2006
Last updated
06/28/2012
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