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Individual

KYLE DAVID PETERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3600 GATES BLVD, PORT ARTHUR, TX 77642-3858
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
(800) 893-9698

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
N4663
TX

Other

Enumeration date
11/10/2009
Last updated
11/10/2009
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