Healthcare Provider Details

I. General information

NPI: 1164538914
Provider Name (Legal Business Name): DARREN L PETERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 WALLACE BLVD
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9558
  • Fax: 806-354-5693
Mailing address:
  • Phone: 806-414-9558
  • Fax: 806-354-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME95971
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberQ2367
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberQ2367
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberQ2367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: