Individual
DANIEL W PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 541-6026
(731) 541-7958
Mailing address
8900 SPRING GRV N, MOBILE, AL 36695-5327
(251) 604-2152
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
60752
TN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/06/2015
Last updated
04/16/2021
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