Individual
PAUL D PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2207 S CLEAR CREEK RD, STE 304, KILLEEN, TX 76549-4132
(254) 526-2085
(254) 526-9569
Mailing address
PO BOX 4189, AUSTIN HEART, AUSTIN, TX 78765-4189
(512) 206-4300
(512) 206-4350
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
PA01398
TX
363AM0700X
Medical Physician Assistant
Primary
PA01398
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85N216
BC/BS
TX
Enumeration date
08/12/2005
Last updated
10/24/2007
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