Healthcare Provider Details

I. General information

NPI: 1093841397
Provider Name (Legal Business Name): THOMAS DAVID PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 CHARNELTON ST
EUGENE OR
97401-3431
US

IV. Provider business mailing address

1178 CHARNELTON ST
EUGENE OR
97401-3431
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-2253
  • Fax: 541-687-8811
Mailing address:
  • Phone: 541-485-2253
  • Fax: 541-687-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number9287
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: