Healthcare Provider Details

I. General information

NPI: 1114968435
Provider Name (Legal Business Name): ANNE E. PETERSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE E. DABNEY

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BROADWAY STE 240
COLUMBIA MO
65201-8020
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-8145
  • Fax: 573-815-3832
Mailing address:
  • Phone: 573-815-8145
  • Fax: 573-815-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006010643
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: