Individual
DR. LETTY REVELL PETERSON
Active
Individual
DR. LETTY REVELL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
058913
GA
207ND0101X
MOHS-Micrographic Surgery Physician
058913
GA
207NP0225X
Pediatric Dermatology Physician
058913
GA
207NS0135X
Procedural Dermatology Physician
058913
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
551383524A
—
GA
Enumeration date
03/20/2007
Last updated
10/22/2012
Update your record
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