Individual
RYAN S PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
19256
NH
207L00000X
Anesthesiology Physician
Primary
R5451
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033956
—
VT
05
—
3115445
—
NH
Enumeration date
05/07/2014
Last updated
01/27/2022
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