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NPI Code Detail

MEDICARE: JOHN PETERSEN MD

MEDICARE: JOHN PETERSEN 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
1207P00000XEmergency Medicine PhysicianG74917CA
2207R00000XInternal Medicine PhysicianQ0536TX

General Provider Information

NPI Number : 1972506442
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN PETERSEN MD
Provider Business Mailing Address
First Line : 4705 BRIARWOOD AVENUE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 432-505-4145
Fax Number : 833-941-0864
Provider Business Practice Location Address
First Line : 4705 BRIARWOOD AVENUE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 432-505-4145
Fax Number : 833-941-0864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/12/2025

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Directions to “ JOHN PETERSEN MD” Practice Location

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