Individual
DR. ALAN CLIFTON PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 746-0516
(208) 746-4989
Mailing address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 746-0516
(208) 746-4989
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M-9571
ID
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD00046440
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807462200
—
ID
Enumeration date
05/26/2006
Last updated
10/24/2014
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