MEDICARE: DR. BEN PETERSON

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	225400000X	Rehabilitation Practitioner
2	174400000X	Specialist

General Provider Information

NPI Number	:	1972381432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN PETERSON

Provider Business Mailing Address
First Line	:	1185 BERKSHIRE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1185 BERKSHIRE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-4258
Country	:	US
Telephone Number	:	763-300-8545
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	10/25/2023

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Directions to “ DR. BEN PETERSON ” Practice Location

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