Healthcare Provider Details

I. General information

NPI: 1174978688
Provider Name (Legal Business Name): JEFFREY S PETERSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST SUITE 336
SAN FRANCISCO CA
94102-1401
US

IV. Provider business mailing address

490 POST ST SUITE 336
SAN FRANCISCO CA
94102-1401
US

V. Phone/Fax

Practice location:
  • Phone: 415-578-5590
  • Fax: 415-578-5599
Mailing address:
  • Phone: 415-578-5590
  • Fax: 415-578-5599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA65906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberA65906
License Number StateCA

VIII. Authorized Official

Name: JEFFREY S PETERSON
Title or Position: OWNER
Credential: MD
Phone: 650-704-7094