Individual
DR. GARY J PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10012 KENNERLY RD, SUITE 305, SAINT LOUIS, MO 63128-2197
(314) 525-4325
(314) 525-4365
Mailing address
10012 KENNERLY RD, SUITE 305, SAINT LOUIS, MO 63128-2197
(314) 525-4325
(314) 525-4365
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
R5836
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902900517
—
MO
Enumeration date
09/12/2006
Last updated
05/24/2016
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