Healthcare Provider Details

I. General information

NPI: 1801859129
Provider Name (Legal Business Name): DAVID MORGAN PETERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 SATTLER RD SUITE 6
CANYON LAKE TX
78132-2295
US

IV. Provider business mailing address

1395 SATTLER RD SUITE 6
CANYON LAKE TX
78132-2295
US

V. Phone/Fax

Practice location:
  • Phone: 830-904-4311
  • Fax: 830-885-5541
Mailing address:
  • Phone: 830-904-4311
  • Fax: 830-885-5541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA03914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: