Individual
R.K.DANIEL PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
311 CAMDEN ST, SUITE 208, SAN ANTONIO, TX 78215-2012
(210) 892-0228
(210) 455-0169
Mailing address
PO BOX 2947, SAN ANTONIO, TX 78299-2947
(210) 892-0228
(210) 455-0169
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D6128
TX
2085R0204X
Vascular & Interventional Radiology Physician
D6128
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00141555
MEDICARE RAILROAD
—
Enumeration date
02/21/2006
Last updated
02/01/2011
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