Individual
DR. LESLIE MICHAEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
501 MORRIS ST FL 5, CHARLESTON, WV 25301-1326
(304) 388-7170
(304) 388-1858
Mailing address
501 MORRIS ST FL 5, CHARLESTON, WV 25301-1326
(304) 388-7170
(304) 388-1858
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2410
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730341264
—
VA
Enumeration date
06/26/2008
Last updated
01/21/2014
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