Individual
WILLIAM G. PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 WALLACE BLVD, AMARILLO, TX 79106-1799
(806) 212-2129
(806) 212-2246
Mailing address
PO BOX 840026, DALLAS, TX 75284-0026
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G5477
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101087805
—
TX
01
—
733996
MEDICARE ID
TX
Enumeration date
03/31/2006
Last updated
05/18/2021
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