Individual
JACK A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
180 N FRANKLIN ST STE B, COCHRANTON, PA 16314-9706
(814) 424-1126
(814) 251-1568
Mailing address
1034 GROVE ST, MEADVILLE, PA 16335-2945
(814) 425-1126
(814) 425-1156
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS008804L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00163946000003
—
PA
Enumeration date
07/07/2006
Last updated
07/06/2021
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