Individual
DIRK PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 DEL PRADO BLVD S STE 100, CAPE CORAL, FL 33990
(239) 424-2060
(239) 424-2061
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 424-2060
(239) 424-2061
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
ME69232
FL
207VG0400X
Gynecology Physician
Primary
ME69232
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256918300
—
FL
Enumeration date
09/29/2005
Last updated
04/25/2023
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