Healthcare Provider Details

I. General information

NPI: 1477533586
Provider Name (Legal Business Name): RONALD TODD PETERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 EYE ST
BAKERSFIELD CA
93301-2006
US

IV. Provider business mailing address

PO BOX 82396
BAKERSFIELD CA
93380-2396
US

V. Phone/Fax

Practice location:
  • Phone: 661-395-3000
  • Fax: 661-323-4703
Mailing address:
  • Phone: 661-323-5918
  • Fax: 661-323-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A7104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: