Healthcare Provider Details

I. General information

NPI: 1043621048
Provider Name (Legal Business Name): ERIK THOMAS PETERSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 JEFFERSON ST STE 200
AUSTIN TX
78731-6200
US

IV. Provider business mailing address

915 GESSNER RD STE 640
HOUSTON TX
77024-2538
US

V. Phone/Fax

Practice location:
  • Phone: 512-643-4384
  • Fax:
Mailing address:
  • Phone: 713-984-0010
  • Fax: 713-984-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR6258
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberR6258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: