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General NPI Number Information
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NPI Number | 1528024072
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Entity Type | Individual
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Provider Name | W JOSEPH PETERSON DOM, AP
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Gender | Male
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12100 COBBLESTONE DR STE 3
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City | BAYONET POINT
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State | FL
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Zip | 34667-2487
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Country | US
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Telephone | 727-378-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 12100 COBBLESTONE DR STE 3
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City | BAYONET POINT
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State | FL
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Zip | 34667-2487
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Country | US
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Telephone | 727-378-7469
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP-1568
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License Number State | FL
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