Healthcare Provider Details

I. General information

NPI: 1003387291
Provider Name (Legal Business Name): RENE' A PETERSON, DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35202 ATLANTIC AVE
MILLVILLE DE
19967
US

IV. Provider business mailing address

35202 ATLANTIC AVE
MILLVILLE DE
19967
US

V. Phone/Fax

Practice location:
  • Phone: 302-541-0323
  • Fax: 302-539-8736
Mailing address:
  • Phone: 302-541-0323
  • Fax: 302-539-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RENE' PETERSON
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 302-541-0323