Individual
DR. KIM A PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
610 NW 11TH ST, HERMISTON, OR 97838-6601
(541) 667-3439
(541) 667-3414
Mailing address
PO BOX 1724, HERMISTON, OR 97838-3724
(541) 564-9034
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DO16339
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077920
—
OR
Enumeration date
07/04/2006
Last updated
07/08/2007
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