Individual
MR. TODD J PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6854 PARKER RD, FLORISSANT, MO 63033-5313
(314) 286-6988
(314) 868-2561
Mailing address
6854 PARKER RD, FLORISSANT, MO 63033-5313
(314) 286-6988
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002723
IL
Other
Enumeration date
10/24/2005
Last updated
04/15/2024
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