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General NPI Number Information
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NPI Number | 1629127915
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Entity Type | Individual
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Provider Name | STEPHEN PAUL PETERSON MD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 8300 HEALTH PARK STE 107
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City | RALEIGH
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State | NC
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Zip | 27615-4731
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Country | US
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Telephone | 919-238-2000
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Fax | 919-238-5010
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Provider Business Mailing Address
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Address Line | PO BOX 604337
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City | CHARLOTTE
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State | NC
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Zip | 28260-4337
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Country | US
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Telephone | 919-238-2000
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Fax | 919-238-5010
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 45762
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 2019-01557
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019-01557
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License Number State | NC
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