Individual
GILMAN P. PETERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 BRAVO BLVD, GLASGOW, KY 42141-3412
(270) 651-8328
(270) 651-1731
Mailing address
109 BRAVO BLVD, GLASGOW, KY 42141-3412
(270) 651-8328
(270) 651-1731
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20017
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64200173
—
KY
Enumeration date
04/08/2006
Last updated
09/18/2014
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