Healthcare Provider Details

I. General information

NPI: 1417957234
Provider Name (Legal Business Name): JOHN L PETERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 CENTURY PLACE
HICKORY NC
28603
US

IV. Provider business mailing address

PO BOX 3710
HICKORY NC
28603-3710
US

V. Phone/Fax

Practice location:
  • Phone: 828-324-9550
  • Fax: 828-324-4154
Mailing address:
  • Phone: 828-324-9550
  • Fax: 828-324-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number15487
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number042-0012323
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number38166
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: