Individual
KEERTI KIRUN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
801 E WHITESTONE BLVD STE C, CEDAR PARK, TX 78613
(512) 259-3467
(512) 406-7303
Mailing address
6210 E HIGHWAY 290 STE 240, AUSTIN, TX 78723-1144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
R5795
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382843601
—
TX
05
—
382843602
—
TX
Enumeration date
04/29/2013
Last updated
03/25/2021
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