Individual
DR. JOHN PETER PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3555 10TH COURT, INDIAN RIVER REGIONAL CANCER CENTER, IRMC, VERO BEACH, FL 32960-4862
(772) 794-3333
(772) 569-6949
Mailing address
3555 10TH CT, VERO BEACH, FL 32960-5013
(772) 794-3333
(772) 569-6949
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME 64848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374792100
—
FL
01
—
920004346
MEDICARE RR
—
Enumeration date
08/10/2005
Last updated
03/24/2020
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