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General NPI Number Information
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NPI Number | 1336491612
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Entity Type | Organization
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Legal Business Name | DOUGLAS E. PETERSON, LLC
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 4 STATE RD
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City | DANVERS
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State | MA
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Zip | 01923-2567
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Country | US
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Telephone | 978-774-3400
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Fax | 978-774-5883
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Provider Business Mailing Address
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Address Line | 4 STATE RD
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City | DANVERS
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State | MA
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Zip | 01923-2567
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Country | US
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Telephone | 978-774-3400
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Fax | 978-774-5883
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Authorized Official
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Title or Position | ORTHOPEDIC SURGEON
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Name | DR. DOUGLAS EDWARD PETERSON
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Credential | D.O.
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Telephone | 978-774-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 153208
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License Number State | MA
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