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General NPI Number Information
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NPI Number | 1396743548
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Entity Type | Individual
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Provider Name | DONALD DOUGLAS PETERSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 408 8TH ST 1ST FLOOR
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-4167
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Country | US
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Telephone | 336-838-4158
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Fax | 336-838-5361
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-0159
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Country | US
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Telephone | 336-838-4158
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Fax | 336-838-5361
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 21502
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License Number State | NC
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