Individual
JAMES H PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 BREVCO PLZ, SUITE 208, LAKE ST LOUIS, MO 63367-2949
(636) 561-9020
Mailing address
200 BREVCO PLZ, SUITE 208, LAKE ST LOUIS, MO 63367-2949
(636) 561-9020
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MOR7B69
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831169275
—
MO
05
—
202263828
—
MO
01
—
24528
BC/BS MISSOURI
MO
01
—
P01021819
RAILROAD MEDICARE
MO
Enumeration date
01/26/2006
Last updated
07/18/2014
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