Individual
JEFFREY B PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
259 MAIN STREET, YARMOUTH, ME 04096
(207) 846-9602
(207) 846-6714
Mailing address
100 FODEN ROAD WEST, SUITE 203, SOUTH PORTLAND, ME 04106
(207) 828-0361
(207) 874-1483
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
016870
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431962899
—
ME
Enumeration date
07/12/2006
Last updated
04/21/2011
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