Individual
STEVEN WARREN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1315 WATERS EDGE DR, SUITE # 107, GRANBURY, TX 76048-1300
(817) 579-5476
(817) 579-5489
Mailing address
1315 WATERS EDGE DR, SUITE # 107, GRANBURY, TX 76048-1300
(817) 579-5476
(817) 579-5489
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L7110
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1254425
—
IA
05
—
219230401
—
TX
Enumeration date
07/10/2006
Last updated
08/16/2011
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