Individual
DR. JOHN DAVID PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8300 CARMEL AVE NE, #501, ALBUQUERQUE, NM 87122-3147
(505) 797-1001
Mailing address
3821 MOUNT RAINIER DR NE, ALBUQUERQUE, NM 87111-4356
(276) 644-6880
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
59.000337
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59.000337
OHIO LISCENSE TRAINING CERTIFICATE
OH
Enumeration date
11/15/2010
Last updated
07/17/2013
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