Individual
CHRISTIAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W FORT ST # 111R, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1536
Mailing address
500 W FORT ST # 111R, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1536
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
207R00000X
Internal Medicine Physician
Primary
MRM-2360
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/08/2018
Last updated
05/17/2024
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