MEDICARE: DR. DAVID ALAN PETERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A87648	CA
2	2086S0129X	Vascular Surgery Physician	01080233A	IN
3	2086S0129X	Vascular Surgery Physician	2008-00797	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023230729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALAN PETERSON MD

Provider Business Mailing Address
First Line	:	9633 BITTER MELON DR
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-5917
Country	:	US
Telephone Number	:	919-639-8900
Fax Number	:	919-639-9500

Provider Business Practice Location Address
First Line	:	9633 BITTER MELON DR
Second Line	:
City	:	ANGIER
State	:	NC
Zip	:	27501-5917
Country	:	US
Telephone Number	:	919-639-8900
Fax Number	:	919-639-9500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	04/02/2019

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