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General NPI Number Information
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NPI Number | 1174579874
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Entity Type | Individual
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Provider Name | DARRYL W. PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2803 EARL RUDDER FWY S STE 202
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City | COLLEGE STATION
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State | TX
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Zip | 77845-6099
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Country | US
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Telephone | 979-731-8888
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Fax | 979-731-8935
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Provider Business Mailing Address
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Address Line | 2800 S TEXAS AVE STE 202
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City | BRYAN
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State | TX
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Zip | 77802-5361
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Country | US
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Telephone | 979-774-2061
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Fax | 979-776-5914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | K3391
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | K3391
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 12182R
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License Number State | LA
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