Healthcare Provider Details

I. General information

NPI: 1548317175
Provider Name (Legal Business Name): ROBERT CLAYTON PETERMAN DOM, LMT, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BECK AVE
CODY WY
82414-3928
US

IV. Provider business mailing address

PO BOX 2172
CODY WY
82414-2172
US

V. Phone/Fax

Practice location:
  • Phone: 307-587-5951
  • Fax:
Mailing address:
  • Phone: 307-587-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberDOM 775
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000703
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4307
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: