Healthcare Provider Details

I. General information

NPI: 1679936728
Provider Name (Legal Business Name): KATHERINE PETERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ #MS 390
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1 BAYLOR PLZ #MS 390
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-8070
  • Fax:
Mailing address:
  • Phone: 713-798-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301502274
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: