Individual
DR. SHAWN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1700 NICHOLASVILLE RD STE 1100, LEXINGTON, KY 40503-1466
(859) 276-0414
Mailing address
5200 COMMERCE CROSSING, 3RD FLOOR, LOUISVILLE, KY 40229-2182
(502) 253-4900
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R3588
KY
207RH0000X
Hematology (Internal Medicine) Physician
50117
KY
207RX0202X
Medical Oncology Physician
Primary
50117
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100367380
—
KY
Enumeration date
06/21/2014
Last updated
12/07/2020
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