Individual
PATRICIA J. PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 501-3601
(360) 501-3648
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 501-3601
(360) 501-3648
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00017283
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110194835
RR MEDICARE
—
01
—
126459
LABOR & IND.
WA
05
—
218636
—
OR
05
—
8239071
—
WA
01
—
8923175
CRIME VICTIMS
WA
Enumeration date
08/09/2005
Last updated
07/30/2012
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