Individual
ALAN C PETERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1750 LAUREL STREET, COLUMBIA, SC 29201
(803) 779-3378
(803) 779-3103
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16553
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165537
—
SC
Enumeration date
03/23/2006
Last updated
11/10/2020
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