Individual
DAVID L PETERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3280 E LANARK DR, MERIDIAN, ID 83642-5982
(208) 377-4400
(208) 377-4416
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 377-4400
(208) 377-4416
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M4174
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003885200
—
ID
Enumeration date
06/17/2006
Last updated
01/29/2020
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