Organization
JOSEPH R. PETERSEN, M.D.
Active
Other names
Orthopedic Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH R PETERSEN I M.D. (PHYSICIAN/OWNER)
(208) 678-1138
Entity
Organization
Contact information
Practice address
1344 HILAND AVE STE A, BURLEY, ID 83318-1564
(208) 678-1138
(208) 678-5833
Mailing address
1344 HILAND AVE STE A, P. O. BOX 1263, BURLEY, ID 83318-1564
(208) 678-1138
(208) 678-5833
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M5283
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225105604
NPI INDIV
—
Enumeration date
03/19/2008
Last updated
03/19/2008
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