Individual
GREGORY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-0111
Mailing address
3500 GASTON AVE, DALLAS, TX 75246-2017
(214) 820-0111
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
BP20055598
TX
207R00000X
Internal Medicine Physician
BP10052636
TX
Other
Enumeration date
05/11/2015
Last updated
06/13/2016
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