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Individual

KEVIN PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
3551 RODGER BROOKE DR, JBSA-FORT SAM HOUSTON, TX 78234-4504
(210) 916-8666
(210) 916-8712
Mailing address
3551 RODGER BROOKE DR, ANESTHESIA RESIDENCY, JBSA-FORT SAM HOUSTON, TX 78234-4504
(210) 916-8666

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
S0534
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
S0534
TX
208D00000X
General Practice Physician
S0534
TX

Other

Enumeration date
02/27/2017
Last updated
06/17/2022
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