Individual
MARK DELANO PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1311 E BARNETT RD, STE 201, MEDFORD, OR 97504-8225
(541) 779-5007
(541) 779-5022
Mailing address
1311 E BARNETT RD, STE 201, MEDFORD, OR 97504-8225
(541) 779-5007
(541) 779-5022
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
MD18861
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128129
—
OR
Enumeration date
10/12/2005
Last updated
09/17/2013
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