Healthcare Provider Details

I. General information

NPI: 1376938043
Provider Name (Legal Business Name): ERIC PETERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S UNION AVE STE 100
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-5000
  • Fax: 330-596-6505
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57.026651
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101268214
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: